Provider Demographics
NPI:1083955561
Name:UNTERFRANZ, TOBIAS (LPCC)
Entity Type:Individual
Prefix:
First Name:TOBIAS
Middle Name:
Last Name:UNTERFRANZ
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 MONTGOMERY BLVD NE APT 409B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1312
Mailing Address - Country:US
Mailing Address - Phone:630-707-0807
Mailing Address - Fax:
Practice Address - Street 1:4701 MONTANO RD NW STE 102
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2427
Practice Address - Country:US
Practice Address - Phone:505-350-8452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0200651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM17602904Medicaid