Healthcare Provider Details

I. General information

NPI: 1932341971
Provider Name (Legal Business Name): ALEC B. CARPENTER M.A., LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST N-10D
SANTA FE NM
87505-2143
US

IV. Provider business mailing address

2019 GALISTEO ST N-10D
SANTA FE NM
87505-2143
US

V. Phone/Fax

Practice location:
  • Phone: 505-231-1543
  • Fax: 505-982-8098
Mailing address:
  • Phone: 505-231-1543
  • Fax: 505-982-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0117831
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: