Healthcare Provider Details

I. General information

NPI: 1720136864
Provider Name (Legal Business Name): DEBRA VETTERMAN LPCC, LPAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 BRYN MAWR DR SE STE A
ALBUQUERQUE NM
87106-2265
US

IV. Provider business mailing address

PO BOX 622
MOUNTAINAIR NM
87036-0622
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-2006
  • Fax: 505-847-0681
Mailing address:
  • Phone: 505-265-2006
  • Fax: 505-847-0681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC#1753
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: