Healthcare Provider Details

I. General information

NPI: 1720418650
Provider Name (Legal Business Name): KATELYN ALVARADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN MCKAGAN

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 CARSON VALLEY WAY
SANTA FE NM
87508-1451
US

IV. Provider business mailing address

100 RIO VISTA PL APT 120
SANTA FE NM
87501-1502
US

V. Phone/Fax

Practice location:
  • Phone: 505-309-1963
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB2023-0970
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: