Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XM0800X | Mental Health | 14687 | CA |
Y | 225XM0800X | Mental Health | 3185 | NM |
NPI | 1417325432 |
---|---|
Provider Name | Allison Weber |
First Address | Albuquerque, NM 87123-4708 |
Second Address | Albuquerque, NM 87108-5153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2015 |
Last Update Date | 28/02/2017 |