Healthcare Provider Details

I. General information

NPI: 1255806923
Provider Name (Legal Business Name): KIRAN ARYAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E SANTA FE AVE
GRANTS NM
87020-2443
US

IV. Provider business mailing address

7220 MCCALLUM BLVD APT 1716
DALLAS TX
75252-6179
US

V. Phone/Fax

Practice location:
  • Phone: 318-791-6167
  • Fax:
Mailing address:
  • Phone: 318-791-6167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT-CTL0199051
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: