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NPI Code Detail

MEDICARE: MISS AMY SAGE RUPP LPCC

MEDICARE: MISS AMY SAGE RUPP LPCC
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
1101YM0800XMental Health Counselor0122421NM

General Provider Information

NPI Number : 1598098261
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS AMY SAGE RUPP LPCC
Provider Business Mailing Address
First Line : 1025 HERMOSA DR SE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87108-4312
Country : US
Telephone Number : 505-266-7711
Fax Number : 505-268-5046
Provider Business Practice Location Address
First Line : 1025 HERMOSA DR SE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87108-4312
Country : US
Telephone Number : 505-266-7711
Fax Number : 505-268-5046
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2009
Last Update Date : 09/14/2009

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Directions to “ MISS AMY SAGE RUPP LPCC” Practice Location

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