Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 0146461 | NM |
NPI | 1003162355 |
---|---|
Provider Name | Julie Marie Raborn |
First Address | Albuquerque, NM 87102-2311 |
Second Address | Albuquerque, NM 87102-2311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2012 |
Last Update Date | 24/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NM600653 | (05) | NM |