Healthcare Provider Details

I. General information

NPI: 1265636344
Provider Name (Legal Business Name): EMILY TARA ANN KEE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 YALE SE SUITE C6
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

10600 SATELLITE ST NW
ALBUQUERQUE NM
87114-3979
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-4622
  • Fax: 505-247-1373
Mailing address:
  • Phone: 505-264-2476
  • Fax: 505-247-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM4499
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: