Healthcare Provider Details

I. General information

NPI: 1477848752
Provider Name (Legal Business Name): CAROL K MARTELL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 COLUMBIA ST
SANTA FE NM
87505-3965
US

IV. Provider business mailing address

1210 PLACITA LOMA
SANTA FE NM
87501-1613
US

V. Phone/Fax

Practice location:
  • Phone: 505-227-0024
  • Fax:
Mailing address:
  • Phone: 505-400-4936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0129921
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: