Healthcare Provider Details

I. General information

NPI: 1780941500
Provider Name (Legal Business Name): STEPHANIE MICHELLE ALBURY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 5TH ST SUITE B
SANTA FE NM
87505-5402
US

IV. Provider business mailing address

1919 5TH ST SUITE B
SANTA FE NM
87505-5402
US

V. Phone/Fax

Practice location:
  • Phone: 505-409-1271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0149091
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: