Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | .0588 | NM |
NPI | 1003898222 |
---|---|
Provider Name | Dr. Patricia Marie Telles |
First Address | Albuquerque, NM 87107-5405 |
Second Address | Albuquerque, NM 87107-5405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 08/07/2007 |