Healthcare Provider Details

I. General information

NPI: 1073542833
Provider Name (Legal Business Name): KATHERINE DENISE DUDLEY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE RABOLD

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MORRIS RD SE
LOS LUNAS NM
87031-5242
US

IV. Provider business mailing address

2551 COORS BLVD NW
ALBUQUERQUE NM
87120-1213
US

V. Phone/Fax

Practice location:
  • Phone: 505-866-2318
  • Fax: 505-887-9579
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0092361
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number119801
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: