Healthcare Provider Details

I. General information

NPI: 1780675769
Provider Name (Legal Business Name): PATRICIA M BURR MA, LPCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA MARTINEZ BURR MA, LPCC, NCC

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 4TH ST NW STE F
ALBUQUERQUE NM
87107-5800
US

IV. Provider business mailing address

6501 4TH ST NW STE F
ALBUQUERQUE NM
87107-5800
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-0366
  • Fax: 505-247-0376
Mailing address:
  • Phone: 505-247-0366
  • Fax: 505-247-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2191
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: