Provider Demographics
NPI:1982342747
Name:LEGRAND, ALISON J (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:J
Last Name:LEGRAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SOLANA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1654
Mailing Address - Country:US
Mailing Address - Phone:505-670-2296
Mailing Address - Fax:
Practice Address - Street 1:119 SOLANA DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1654
Practice Address - Country:US
Practice Address - Phone:505-670-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1637103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1637OtherNM REGULATION & LICENSING DEPARTMENT