Healthcare Provider Details

I. General information

NPI: 1427807189
Provider Name (Legal Business Name): ALDER AND OAK COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CERRILLOS RD STE 303
SANTA FE NM
87507-2694
US

IV. Provider business mailing address

3600 CERRILLOS RD STE 303
SANTA FE NM
87507-2694
US

V. Phone/Fax

Practice location:
  • Phone: 505-257-8554
  • Fax: 505-930-7813
Mailing address:
  • Phone: 505-257-8554
  • Fax: 505-930-7813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CASEY CAMERON DEXTER
Title or Position: OWNER, THERAPIST
Credential: LCSW
Phone: 505-257-8554