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NPI Code Detail

MEDICARE: MS. KATHLEEN LUELLEN CHABOT LPCC

MEDICARE: MS. KATHLEEN LUELLEN CHABOT 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
1101YP2500XProfessional CounselorC1498OR
2101YP2500XProfessional Counselor0141941NM

General Provider Information

NPI Number : 1912201161
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHLEEN LUELLEN CHABOT LPCC
Provider Business Mailing Address
First Line : 4608 ALMERIA DR NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87120-1840
Country : US
Telephone Number : 505-934-0934
Fax Number :
Provider Business Practice Location Address
First Line : 6666 4TH ST NW
Second Line : SUITE D
City : LOS RANCHOS
State : NM
Zip : 87107-6144
Country : US
Telephone Number : 505-934-0934
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2011
Last Update Date : 02/26/2014

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