Healthcare Provider Details

I. General information

NPI: 1386520773
Provider Name (Legal Business Name): STEPHANY CARLSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N ALAMEDA BLVD STE C
LAS CRUCES NM
88005-2610
US

IV. Provider business mailing address

101 N ALAMEDA BLVD STE C
LAS CRUCES NM
88005-2610
US

V. Phone/Fax

Practice location:
  • Phone: 575-618-0375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANY CARLSON
Title or Position: OWNER
Credential: MS, LMFT
Phone: 575-618-0375