Healthcare Provider Details

I. General information

NPI: 1285169912
Provider Name (Legal Business Name): ALETA ALEXANDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 CARSON TRL NW
ALBUQUERQUE NM
87120-4513
US

IV. Provider business mailing address

1005 21ST ST SE SUITE 19
RIO RANCHO NM
87124-4030
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-0834
  • Fax: 505-280-9607
Mailing address:
  • Phone: 505-400-0834
  • Fax: 505-280-9607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0130591
License Number StateNM

VIII. Authorized Official

Name: ALETA MYER ALEXNDER
Title or Position: OWNER
Credential: LPCC
Phone: 505-400-0834