Healthcare Provider Details

I. General information

NPI: 1740474808
Provider Name (Legal Business Name): FRANCES CAROLE CIULLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 7TH ST
LAS VEGAS NM
87701-4920
US

IV. Provider business mailing address

5312 JAGUAR DR TEAMBUILDERS COUNSELING SERVICES
SANTA FE NM
87507-1827
US

V. Phone/Fax

Practice location:
  • Phone: 505-454-8265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPAT # 1335
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: