Healthcare Provider Details

I. General information

NPI: 1104066950
Provider Name (Legal Business Name): JOE DEBONIS LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MENAUL BLVD NE
ALBUQUERQUE NM
87107-1851
US

IV. Provider business mailing address

2300 MENAUL BLVD NE
ALBUQUERQUE NM
87107-1851
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3825
  • Fax: 505-272-0277
Mailing address:
  • Phone: 505-272-3825
  • Fax: 505-272-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1021
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: