Healthcare Provider Details

I. General information

NPI: 1275310450
Provider Name (Legal Business Name): KELSEY CORRAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 EL PASEO RD STE B
LAS CRUCES NM
88001-6019
US

IV. Provider business mailing address

2918 MAJESTIC RDG APT A
LAS CRUCES NM
88011-5138
US

V. Phone/Fax

Practice location:
  • Phone: 575-243-5846
  • Fax:
Mailing address:
  • Phone: 575-543-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2024-0207
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: