Provider Demographics
NPI:1790330207
Name:ALDER AND OAK COUNSELING LLC
Entity Type:Organization
Organization Name:ALDER AND OAK COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:DEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:520-909-6264
Mailing Address - Street 1:3600 CERRILLOS RD STE 307
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2694
Mailing Address - Country:US
Mailing Address - Phone:520-909-6264
Mailing Address - Fax:
Practice Address - Street 1:1350 CENTRAL AVE STE 204
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-6218
Practice Address - Country:US
Practice Address - Phone:520-909-6264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALDER AND OAK COUNSELING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13726731Medicaid