Healthcare Provider Details

I. General information

NPI: 1699013169
Provider Name (Legal Business Name): PATRICIA MARTINEZ BURR, MA, LPCC, NCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6666 4TH ST NW SUITE B
LOS RANCHOS NM
87107-6144
US

IV. Provider business mailing address

6666 4TH ST NW SUITE B
LOS RANCHOS NM
87107-6144
US

V. Phone/Fax

Practice location:
  • Phone: 505-463-0472
  • Fax: 505-344-7581
Mailing address:
  • Phone: 505-463-0472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2191
License Number StateNM

VIII. Authorized Official

Name: PARICIA MARTINEZ BURR
Title or Position: LICENSED PROFESSIONAL CLINICAL COUN
Credential: MA
Phone: 505-463-0472