Healthcare Provider Details

I. General information

NPI: 1407080302
Provider Name (Legal Business Name): CARLA MARIE BYARS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 SEQUOIA RD NW
ALBUQUERQUE NM
87120-1249
US

IV. Provider business mailing address

340 CUADRO ST SE
ALBUQUERQUE NM
87123-5982
US

V. Phone/Fax

Practice location:
  • Phone: 505-852-3011
  • Fax:
Mailing address:
  • Phone: 505-463-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberM-07535
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-07535
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: