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General NPI Number Information
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NPI Number | 1699013169
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Entity Type | Organization
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Legal Business Name | PATRICIA MARTINEZ BURR, MA, LPCC, NCC
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 6666 4TH ST NW SUITE B
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City | LOS RANCHOS
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State | NM
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Zip | 87107-6144
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Country | US
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Telephone | 505-463-0472
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Fax | 505-344-7581
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Provider Business Mailing Address
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Address Line | 6666 4TH ST NW SUITE B
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City | LOS RANCHOS
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State | NM
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Zip | 87107-6144
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Country | US
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Telephone | 505-463-0472
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL CLINICAL COUN
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Name | PARICIA MARTINEZ BURR
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Credential | MA
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Telephone | 505-463-0472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2191
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License Number State | NM
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