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General NPI Number Information
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NPI Number | 1053342659
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Entity Type | Individual
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Provider Name | CAROLYN TJOLAND LPCC
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 901 W ALAMEDA ST SUITE 25
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City | SANTA FE
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State | NM
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Zip | 87501-1681
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Country | US
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Telephone | 505-955-9436
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Fax | 505-955-9437
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Provider Business Mailing Address
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Address Line | PO BOX 23302
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City | SANTA FE
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State | NM
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Zip | 87502-3302
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Country | US
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Telephone | 505-577-1919
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPCC 3086
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPCC 3086
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License Number State | NM
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