Healthcare Provider Details

I. General information

NPI: 1588861702
Provider Name (Legal Business Name): CHARLENE K TEMPLET LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLENE PENDLETON

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W. GRIGGS ST
LAS CRUCES NM
88001
US

IV. Provider business mailing address

100 W GRIGGS AVE
LAS CRUCES NM
88001-1234
US

V. Phone/Fax

Practice location:
  • Phone: 575-647-2800
  • Fax: 575-647-2898
Mailing address:
  • Phone: 575-647-2800
  • Fax: 575-647-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2007018129
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0153331
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0163621
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: