Healthcare Provider Details

I. General information

NPI: 1285267807
Provider Name (Legal Business Name): RICKEY MARTIN APODACA LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO # 63870
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

1508 MESILLA ST NE
ALBUQUERQUE NM
87110-7230
US

V. Phone/Fax

Practice location:
  • Phone: 505-277-3136
  • Fax: 505-277-2020
Mailing address:
  • Phone: 505-417-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0207951
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: