Healthcare Provider Details

I. General information

NPI: 1497784292
Provider Name (Legal Business Name): AMBER DEON MCEACHERN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CARLISLE BLVD NE STE F
ALBUQUERQUE NM
87110-5667
US

IV. Provider business mailing address

1400 CARLISLE BLVD NE STE F
ALBUQUERQUE NM
87110-5667
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-1959
  • Fax: 505-369-1851
Mailing address:
  • Phone: 505-503-1959
  • Fax: 505-545-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1016
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8349
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1190
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1190
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: