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General NPI Number Information
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NPI Number | 1437866100
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Entity Type | Individual
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Provider Name | CAROLYN SHAYTE CTB
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Gender | Female
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 49 CAMINO BAJO
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City | SANTA FE
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State | NM
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Zip | 87508-8614
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Country | US
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Telephone | 505-474-7684
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Fax |
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Provider Business Mailing Address
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Address Line | 256 PLAZA CANADA # A
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City | SANTA FE
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State | NM
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Zip | 87501-2373
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Country | US
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Telephone | 443-955-3351
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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 | CTB-2022-0862
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License Number State | NM
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