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General NPI Number Information
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NPI Number | 1417279233
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Entity Type | Organization
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Legal Business Name | LISA B. PARTYKA, PH.D. LLC
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Dates
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Enumeration Date | 02/20/2010
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Last Update Date | 02/20/2010
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Provider Practice Location Address
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Address Line | 4314 TEWA CT
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City | LAS CRUCES
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State | NM
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Zip | 88011-4348
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Country | US
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Telephone | 575-647-8040
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Fax |
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Provider Business Mailing Address
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Address Line | 2145 EL PASEO RD
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City | LAS CRUCES
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State | NM
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Zip | 88001-6008
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Country | US
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Telephone | 575-647-8040
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. LISA B. PARTYKA
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Credential | PH.D.
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Telephone | 575-647-8040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 03176603000
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License Number State | NM
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