Provider Demographics
NPI:1639918253
Name:CARRIE NASSIF PHD LLC
Entity type:Organization
Organization Name:CARRIE NASSIF PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-623-4447
Mailing Address - Street 1:PO BOX 1497
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-1497
Mailing Address - Country:US
Mailing Address - Phone:785-623-4447
Mailing Address - Fax:
Practice Address - Street 1:10A BAD DOG RD
Practice Address - Street 2:
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529-4402
Practice Address - Country:US
Practice Address - Phone:785-623-4447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty