Healthcare Provider Details

I. General information

NPI: 1134093776
Provider Name (Legal Business Name): NORTH STAR BEHAVIORAL CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2025
Last Update Date: 10/04/2025
Certification Date: 10/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 THUNDER RIDGE RD
SANTA FE NM
87501-8874
US

IV. Provider business mailing address

4139 ARBOLES BONITOS
SANTA FE NM
87507-1007
US

V. Phone/Fax

Practice location:
  • Phone: 323-493-0517
  • Fax:
Mailing address:
  • Phone: 323-493-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ALIX LANCASTER
Title or Position: CEO
Credential: BCBA, IBA
Phone: 323-493-0517