Healthcare Provider Details

I. General information

NPI: 1205471968
Provider Name (Legal Business Name): STEPHANY CARLSON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2019
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 MESILLA DR
CHAPARRAL NM
88081-7619
US

IV. Provider business mailing address

836 MESILLA DR
CHAPARRAL NM
88081-7619
US

V. Phone/Fax

Practice location:
  • Phone: 575-618-0375
  • Fax:
Mailing address:
  • Phone: 575-618-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCTB-2025-0370
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: