Healthcare Provider Details

I. General information

NPI: 1013170471
Provider Name (Legal Business Name): CHRISTI ANNE PICKREN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 AIRPORT RD
LAS VEGAS NM
87701-9415
US

IV. Provider business mailing address

PO BOX 241
RIBERA NM
87560-0241
US

V. Phone/Fax

Practice location:
  • Phone: 505-454-9738
  • Fax: 505-425-9285
Mailing address:
  • Phone: 919-971-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0114641
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: