Healthcare Provider Details

I. General information

NPI: 1023025509
Provider Name (Legal Business Name): EMILIO ROYBAL IX LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PASEO DE PERALTA
SANTA FE NM
87501-9000
US

IV. Provider business mailing address

PO BOX 9823
LAS VEGAS NM
87701-9000
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-9052
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005651
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: