Healthcare Provider Details

I. General information

NPI: 1801978887
Provider Name (Legal Business Name): STUART S KELTER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 EL PASEO RD
LAS CRUCES NM
88001-6008
US

IV. Provider business mailing address

2145 EL PASEO RD
LAS CRUCES NM
88001-6008
US

V. Phone/Fax

Practice location:
  • Phone: 575-527-1015
  • Fax: 575-541-0532
Mailing address:
  • Phone: 575-527-1015
  • Fax: 575-541-0532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number546
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0004
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: