Healthcare Provider Details

I. General information

NPI: 1184746000
Provider Name (Legal Business Name): ROBERT ALEXANDER SAN-CLAIRE LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LUNA CIRCLE NW
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

1001 LUNA CIR NW
ALBUQUERQUE NM
87102-1973
US

V. Phone/Fax

Practice location:
  • Phone: 505-264-4457
  • Fax: 505-345-1295
Mailing address:
  • Phone: 505-264-4457
  • Fax: 505-345-1295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0161331
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: