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NPI Code Detail

MEDICARE: TERESA A DUBUQUE M.A.

MEDICARE: TERESA A DUBUQUE M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor2224NM

General Provider Information

NPI Number : 1396846663
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA A DUBUQUE M.A.
Provider Business Mailing Address
First Line : 7421 GILA RD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87109-3807
Country : US
Telephone Number : 505-822-1623
Fax Number : 505-856-7103
Provider Business Practice Location Address
First Line : 8600 ACADEMY RD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87111-1107
Country : US
Telephone Number : 505-821-3628
Fax Number : 505-856-7103
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 07/08/2007

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Directions to “ TERESA A DUBUQUE M.A.” Practice Location

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