Healthcare Provider Details

I. General information

NPI: 1689437162
Provider Name (Legal Business Name): CORINA MADRID LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 N CANAL ST
CARLSBAD NM
88220-5110
US

IV. Provider business mailing address

PO BOX 2671
ANTHONY NM
88021-2671
US

V. Phone/Fax

Practice location:
  • Phone: 575-885-4836
  • Fax: 505-443-8319
Mailing address:
  • Phone: 575-882-5100
  • Fax: 575-882-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2024-0025
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: