Healthcare Provider Details

I. General information

NPI: 1992170294
Provider Name (Legal Business Name): CHRISTOPHER MAURER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 WESTWIND RD
LAS CRUCES NM
88007-5575
US

IV. Provider business mailing address

1902 WEST WIND RD
LAS CRUCES NM
88007
US

V. Phone/Fax

Practice location:
  • Phone: 575-640-4921
  • Fax:
Mailing address:
  • Phone: 575-640-4921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0156041
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: