Healthcare Provider Details

I. General information

NPI: 1760604722
Provider Name (Legal Business Name): JANICE L SPRATTE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 VIRGINIA ST NE SUITE 200
ALBUQUERQUE NM
87110-4689
US

IV. Provider business mailing address

1769 16TH AVE SE
RIO RANCHO NM
87124-3570
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-4449
  • Fax: 505-296-0497
Mailing address:
  • Phone: 505-892-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006057
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: