Provider Demographics
NPI:1184746000
Name:SAN-CLAIRE, ROBERT ALEXANDER (LPCC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALEXANDER
Last Name:SAN-CLAIRE
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LUNA CIR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1973
Mailing Address - Country:US
Mailing Address - Phone:505-264-4457
Mailing Address - Fax:505-345-1295
Practice Address - Street 1:1001 LUNA CIRCLE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-264-4457
Practice Address - Fax:505-345-1295
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0161331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM71409505OtherDD WAIVER #