Healthcare Provider Details

I. General information

NPI: 1699861542
Provider Name (Legal Business Name): SUSAN LEE VOIGT MA ATR BC LPAT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 1ST STE 532
ROSWELL NM
88203
US

IV. Provider business mailing address

200 W 1ST STE 532
ROSWELL NM
88203
US

V. Phone/Fax

Practice location:
  • Phone: 505-627-0439
  • Fax: 505-622-2750
Mailing address:
  • Phone: 505-627-0439
  • Fax: 505-622-2750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number2756
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number99003
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0085801
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: