Healthcare Provider Details

I. General information

NPI: 1699872564
Provider Name (Legal Business Name): DEBRA ROGERS MA, LPAT, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 PURDUE PL NE
ALBUQUERQUE NM
87106-2124
US

IV. Provider business mailing address

2500 LOS PINOS RD SW
ALBUQUERQUE NM
87105-6725
US

V. Phone/Fax

Practice location:
  • Phone: 505-453-0098
  • Fax: 505-452-9503
Mailing address:
  • Phone: 505-453-0098
  • Fax: 505-452-9503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number66642
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2986
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: