Provider Demographics
NPI:1346609831
Name:CAROLE A. MCKELVEY, LPCC, NCC, MA
Entity Type:Organization
Organization Name:CAROLE A. MCKELVEY, LPCC, NCC, MA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCKELVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-503-9455
Mailing Address - Street 1:PO BOX 6002
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87197-6002
Mailing Address - Country:US
Mailing Address - Phone:505-503-9455
Mailing Address - Fax:
Practice Address - Street 1:3107 11TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1118
Practice Address - Country:US
Practice Address - Phone:505-503-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0083451305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service