Healthcare Provider Details

I. General information

NPI: 1992014997
Provider Name (Legal Business Name): FRED LITMANN ALTENHAUS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2010
Last Update Date: 09/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 MADRID PL
SANTA FE NM
87505-4641
US

IV. Provider business mailing address

1414 MADRID PL
SANTA FE NM
87505-4641
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-4121
  • Fax:
Mailing address:
  • Phone: 505-660-4121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0390
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: