Healthcare Provider Details

I. General information

NPI: 1376950030
Provider Name (Legal Business Name): DEBORAH EHLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 01/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 SPAIN RD NE STE E
ALBUQUERQUE NM
87111-1895
US

IV. Provider business mailing address

13100 CHITALPA PL NE
ALBUQUERQUE NM
87111-8128
US

V. Phone/Fax

Practice location:
  • Phone: 505-273-3282
  • Fax:
Mailing address:
  • Phone: 505-205-9481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: