Healthcare Provider Details

I. General information

NPI: 1720185317
Provider Name (Legal Business Name): BARBARA MOORE MCCANDLISH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 HARKLE RD SUITE C
SANTA FE NM
87505-4784
US

IV. Provider business mailing address

546 HARKLE RD SUITE C
SANTA FE NM
87505-4784
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-9360
  • Fax: 505-988-1480
Mailing address:
  • Phone: 505-982-9360
  • Fax: 505-988-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number203
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number15169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: