Provider Demographics
NPI:1013220409
Name:CARNS, SHELLY L
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:L
Last Name:CARNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6539
Mailing Address - Country:US
Mailing Address - Phone:575-437-8964
Mailing Address - Fax:
Practice Address - Street 1:905 10TH ST STE C
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6402
Practice Address - Country:US
Practice Address - Phone:575-437-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor