Healthcare Provider Details

I. General information

NPI: 1619441227
Provider Name (Legal Business Name): CATHARYN DIANNE CRALL MS, LMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHARYN CRALL

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 CENTRAL AVE STE 214
LOS ALAMOS NM
87544-4017
US

IV. Provider business mailing address

7301 INDIAN SCHOOL RD NE STE A
ALBUQUERQUE NM
87110-4504
US

V. Phone/Fax

Practice location:
  • Phone: 505-309-0505
  • Fax:
Mailing address:
  • Phone: 505-266-0441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0204871
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: