Healthcare Provider Details

I. General information

NPI: 1821148321
Provider Name (Legal Business Name): KEVIN PATTERSON LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 SAN MATEO BLVD NE SUITE S-14
ALBUQUERQUE NM
87110-4058
US

IV. Provider business mailing address

11605 ROSEMONT AVE NE
ALBUQUERQUE NM
87112-5644
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-6500
  • Fax:
Mailing address:
  • Phone: 505-275-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0099471
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: