Healthcare Provider Details

I. General information

NPI: 1609168319
Provider Name (Legal Business Name): STACEY CARVER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HILLRISE CIR
LAS CRUCES NM
88011-4759
US

IV. Provider business mailing address

1350 HILLRISE CIR
LAS CRUCES NM
88011-4759
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-9500
  • Fax: 575-523-1108
Mailing address:
  • Phone: 575-522-9500
  • Fax: 575-523-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0134321
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: