Healthcare Provider Details

I. General information

NPI: 1578793550
Provider Name (Legal Business Name): ALEXANDRA E PITT M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 OLD PECOS TRL STE P
SANTA FE NM
87505-4759
US

IV. Provider business mailing address

1800 OLD PECOS TRL STE P
SANTA FE NM
87505-4759
US

V. Phone/Fax

Practice location:
  • Phone: 505-795-8447
  • Fax: 505-213-0337
Mailing address:
  • Phone: 505-795-8447
  • Fax: 505-213-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0142481
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0161941
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: