Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 08412 | NM |
NPI | 1003245952 |
---|---|
Provider Name | Katy Minder |
First Address | Silver City, NM 88061-5313 |
Second Address | Silver City, NM 88061-5313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2013 |
Last Update Date | 01/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26209233 | (05) | NM |