Healthcare Provider Details

I. General information

NPI: 1346707601
Provider Name (Legal Business Name): CARMEN ULIBARRI LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 HOT SPRINGS BLVD
LAS VEGAS NM
87701-3734
US

IV. Provider business mailing address

2313 HOT SPRINGS BLVD
LAS VEGAS NM
87701-3734
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-2913
  • Fax: 505-425-2913
Mailing address:
  • Phone: 505-425-2913
  • Fax: 505-425-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0197521
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0216761
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: