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General NPI Number Information
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NPI Number | 1134324270
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Entity Type | Individual
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Provider Name | ASHLEY ALEXANDRA ROETHLER MA
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Gender | Female
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 2403 SAN MATEO BLVD NE SUITE W-10
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-4058
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Country | US
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Telephone | 505-830-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 9 HOPI DR
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City | LOS LUNAS
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State | NM
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Zip | 87031-6291
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Country | US
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Telephone | 505-319-5559
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0102371
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License Number State | NM
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