Provider Demographics
NPI:1619441227
Name:CRALL, CATHARYN DIANNE (MS, LMHC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:CATHARYN
Middle Name:DIANNE
Last Name:CRALL
Suffix:
Gender:F
Credentials:MS, LMHC, NCC
Other - Prefix:
Other - First Name:CATHARYN
Other - Middle Name:
Other - Last Name:CRALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7301 INDIAN SCHOOL RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4504
Mailing Address - Country:US
Mailing Address - Phone:505-266-0441
Mailing Address - Fax:
Practice Address - Street 1:1907 CENTRAL AVE STE 214
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4017
Practice Address - Country:US
Practice Address - Phone:505-309-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NMCMH0204871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM38406861Medicaid