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General NPI Number Information
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NPI Number | 1639918253
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Entity Type | Organization
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Legal Business Name | CARRIE NASSIF PHD LLC
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 10A BAD DOG RD
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City | EL PRADO
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State | NM
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Zip | 87529-4402
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Country | US
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Telephone | 785-623-4447
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1497
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City | EL PRADO
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State | NM
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Zip | 87529-1497
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Country | US
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Telephone | 785-623-4447
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARRIE NASSIF
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Credential |
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Telephone | 785-623-4447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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