Healthcare Provider Details

I. General information

NPI: 1609359348
Provider Name (Legal Business Name): CAITLIN M HARPER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALIENTE RD UNIT 1B
SANTA FE NM
87508-8163
US

IV. Provider business mailing address

3 CALIENTE RD
SANTA FE NM
87508-9209
US

V. Phone/Fax

Practice location:
  • Phone: 630-317-4782
  • Fax:
Mailing address:
  • Phone: 630-317-4782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0205281
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: