Healthcare Provider Details

I. General information

NPI: 1568538155
Provider Name (Legal Business Name): EVE LOREN WEDEEN LPAT, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7103 4TH ST NW
ALBUQUERQUE NM
87107-6641
US

IV. Provider business mailing address

7103 4TH ST NW
ALBUQUERQUE NM
87107-6641
US

V. Phone/Fax

Practice location:
  • Phone: 505-889-2786
  • Fax: 505-872-1050
Mailing address:
  • Phone: 505-889-2786
  • Fax: 505-872-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0541
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: