Provider Demographics
NPI:1497091755
Name:CARR, LINDA (LMT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:LMT
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 3144
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-3144
Mailing Address - Country:US
Mailing Address - Phone:575-770-1187
Mailing Address - Fax:
Practice Address - Street 1:240 ROY RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6641
Practice Address - Country:US
Practice Address - Phone:575-770-1187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCERTIFICATION101Y00000X
NM5626174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor