Healthcare Provider Details

I. General information

NPI: 1316008618
Provider Name (Legal Business Name): KATHERINE IRISH LPCC, LPAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 COORS BLVD NW SUITE 201D
ALBUQUERQUE NM
87120-1173
US

IV. Provider business mailing address

PO BOX 37
PLACITAS NM
87043-0037
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-3520
  • Fax: 505-867-6283
Mailing address:
  • Phone: 505-238-3520
  • Fax: 505-867-6283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5541
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3296
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: