MEDICARE: MISS TAMMY GENISE CALFEE LADAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	006079	NM
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAD0106251	NM
3	101YM0800X	Mental Health Counselor	CMH0198031	NM

General Provider Information

NPI Number	:	1215054119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TAMMY GENISE CALFEE LADAC

Provider Business Mailing Address
First Line	:	PO BOX 92901
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87199-2901
Country	:	US
Telephone Number	:	505-888-1972
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 GOLD AVE SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-3283
Country	:	US
Telephone Number	:	505-715-4610
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	11/14/2023

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