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General NPI Number Information
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NPI Number | 1700217601
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Entity Type | Individual
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Provider Name | MRS. TAMARA SUZANNE BIBO
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Gender | Female
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 2543 WYOMING BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-1037
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Country | US
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Telephone | 505-294-3900
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Fax | 505-294-3904
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Provider Business Mailing Address
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Address Line | PO BOX 2170
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City | TIJERAS
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State | NM
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Zip | 87059-2170
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Country | US
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Telephone | 505-350-1321
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0067282
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License Number State | NM
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