Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 0084851 | NM |
NPI | 1104990845 |
---|---|
Provider Name | Michele Coleman |
First Address | Albuquerque, NM 87108-4312 |
Second Address | Albuquerque, NM 87108-4312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 12/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
86580507 | (05) | NM |