Healthcare Provider Details

I. General information

NPI: 1346485695
Provider Name (Legal Business Name): CARLA KLEEFELD PHD., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650A SANTA FE TRAIL
SANTA FE NM
87501
US

IV. Provider business mailing address

P.O. BOX 2063
SANTA FE NM
87504
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-1582
  • Fax: 505-988-3121
Mailing address:
  • Phone: 505-989-1582
  • Fax: 505-988-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0092001
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: