Healthcare Provider Details

I. General information

NPI: 1497820484
Provider Name (Legal Business Name): JULIE A MADRID LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 VALENTINE WAY
SANTA FE NM
87507-7301
US

IV. Provider business mailing address

2818 VEREDA PONIENTE
SANTA FE NM
87507-9235
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-1951
  • Fax:
Mailing address:
  • Phone: 505-424-4930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number79861
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0105251
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: