Provider Demographics
NPI:1801978887
Name:KELTER, STUART S (PSYD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:S
Last Name:KELTER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 EL PASEO RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-6008
Mailing Address - Country:US
Mailing Address - Phone:575-527-1015
Mailing Address - Fax:575-541-0532
Practice Address - Street 1:2145 EL PASEO RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-6008
Practice Address - Country:US
Practice Address - Phone:575-527-1015
Practice Address - Fax:575-541-0532
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM546103TC0700X
NM0004103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN8405Medicaid