Healthcare Provider Details

I. General information

NPI: 1992870919
Provider Name (Legal Business Name): KATE DAVIS ROGERS LPCC, LPAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 SAN MATEO BLVD NE SUITE S-15
ALBUQUERQUE NM
87110-4058
US

IV. Provider business mailing address

2403 SAN MATEO BLVD NE SUITE S-15
ALBUQUERQUE NM
87110-4058
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-8405
  • Fax: 505-281-8001
Mailing address:
  • Phone: 505-238-8405
  • Fax: 505-281-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2705
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: