1144466681 NPI number — MR. ALFREDO CARLOS SANTISTEVAN JR. MS,LPC,NCC,AADC,LAC

Table of content: MS. ANDREA M HALL F.N.P. (NPI 1265560684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144466681 NPI number — MR. ALFREDO CARLOS SANTISTEVAN JR. MS,LPC,NCC,AADC,LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTISTEVAN
Provider First Name:
ALFREDO
Provider Middle Name:
CARLOS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MS,LPC,NCC,AADC,LAC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144466681
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1430 WILKINS CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-237-9583
Provider Business Mailing Address Fax Number:
307-265-7277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 WILKINS CIRCLE
Provider Second Line Business Practice Location Address:
CENTRAL WYOMING COUNSELING CENTER MEN'S RESIDENTIAL TRE
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-237-9583
Provider Business Practice Location Address Fax Number:
307-265-7277
Provider Enumeration Date:
01/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  LPC 826 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com