Provider Demographics
NPI:1114192283
Name:OTERO, ALICE L (LMHC)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:L
Last Name:OTERO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92002
Mailing Address - Street 2:FORENSIC BEHAVIORAL HEALTH ASSC
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199
Mailing Address - Country:US
Mailing Address - Phone:505-888-5499
Mailing Address - Fax:505-888-5498
Practice Address - Street 1:2202 MENAUL BLVD NE
Practice Address - Street 2:#B C D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107
Practice Address - Country:US
Practice Address - Phone:505-888-5499
Practice Address - Fax:505-888-5498
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM99451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional