Healthcare Provider Details

I. General information

NPI: 1003162355
Provider Name (Legal Business Name): JULIE MARIE RABORN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 1ST ST NW SUITE 200
ALBUQUERQUE NM
87102-2311
US

IV. Provider business mailing address

600 1ST ST NW SUITE 200
ALBUQUERQUE NM
87102-2311
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-9124
  • Fax: 505-847-9503
Mailing address:
  • Phone: 505-224-9124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0146461
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: