Healthcare Provider Details

I. General information

NPI: 1255599411
Provider Name (Legal Business Name): DEBORAH K WIMBERLY M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 GALISTEO ST SUITE B-4
SANTA FE NM
87505-2138
US

IV. Provider business mailing address

140 CALLE OJO FELIZ
SANTA FE NM
87505-5717
US

V. Phone/Fax

Practice location:
  • Phone: 505-501-1845
  • Fax:
Mailing address:
  • Phone: 505-501-1845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005779
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: