Healthcare Provider Details

I. General information

NPI: 1699902973
Provider Name (Legal Business Name): KATHRYN MICHELLE ZAVITZ LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10224 ELMHURST DR NW
ALBUQUERQUE NM
87114-4617
US

IV. Provider business mailing address

10224 ELMHURST DR NW
ALBUQUERQUE NM
87114-4617
US

V. Phone/Fax

Practice location:
  • Phone: 505-604-5357
  • Fax:
Mailing address:
  • Phone: 505-604-5357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0146451
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: