Deadra D. Carrillo, M.A. LPC
Individual provider Active NPI Mental Health Counselor · Bloomfield, NM
NPI 1023154085 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1023154085
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 0510 (NM)
- Practice address
- 333 Road 4990
Bloomfield, NM 87413-9626 - Phone
- (505) 632-6713
- NPI assigned
- Jan 29, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0510 | NM | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 0510 | NM | Yes |
Addresses
Primary practice location
333 Road 4990
Bloomfield, NM 87413-9626
Mailing address
333 Road 4990
Bloomfield, NM 87413-9626
Phone (505) 632-6713
Other providers in Bloomfield, NM
- Jillian Brown
- Katherine Bryson
- Lorna F. Bulwan
- Holly Elizabeth Burns
- Melanie Canode
- Nancy Carter
- Isabella Chavez
- Michelle Childers-Beck
- Terre G Coberly
- Kristi Coddington
All providers in Bloomfield, NM · Mental Health Counselor in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.