Healthcare Provider Details

I. General information

NPI: 1326493370
Provider Name (Legal Business Name): ALEX JOHN THEODORE-SPALDING LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 OLD PECOS TRL STE A
SANTA FE NM
87505-4779
US

IV. Provider business mailing address

1660 OLD PECOS TRL STE A
SANTA FE NM
87505-4779
US

V. Phone/Fax

Practice location:
  • Phone: 505-657-9708
  • Fax: 505-395-9295
Mailing address:
  • Phone: 505-657-9708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0217571
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0013008
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: