Healthcare Provider Details

I. General information

NPI: 1437728490
Provider Name (Legal Business Name): CARMEN ULIBARRI, LPCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
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: 505-429-3241
  • Fax:
Mailing address:
  • Phone: 505-429-3241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CARMEN ULIBARRI
Title or Position: OWNER
Credential: LPCC
Phone: 505-429-3241