MEDICARE: CARRIE PORTS LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	0098171	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376552950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE PORTS LMHC

Provider Business Mailing Address
First Line	:	5721 RIO OSO DR NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-4715
Country	:	US
Telephone Number	:	505-990-9706
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 PARADISE BLVD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-6074
Country	:	US
Telephone Number	:	505-508-0808
Fax Number	:	888-896-8728

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	01/26/2010

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Directions to “ CARRIE PORTS LMHC” Practice Location

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