Provider Demographics
NPI:1194897512
Name:CARLTON, NATALIE RAE (LPCC, ATR-BC)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:RAE
Last Name:CARLTON
Suffix:
Gender:F
Credentials:LPCC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7479 NDCBU
Mailing Address - Street 2:112-B ALEXANDER STREET
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6177
Mailing Address - Country:US
Mailing Address - Phone:505-751-3565
Mailing Address - Fax:505-751-7231
Practice Address - Street 1:7479 NDCBU
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6177
Practice Address - Country:US
Practice Address - Phone:505-751-3565
Practice Address - Fax:505-751-7231
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA0211Medicaid
NMNM100657OtherVALUE OPTIONSD PROVIDER #