Provider Demographics
NPI:1093048597
Name:DENTON, PHYLLIS MCCURDY (LPCC)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:MCCURDY
Last Name:DENTON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 PAN AMERICAN FWY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4786
Mailing Address - Country:US
Mailing Address - Phone:505-222-0331
Mailing Address - Fax:505-222-0365
Practice Address - Street 1:3405 PAN AMERICAN FWY NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4786
Practice Address - Country:US
Practice Address - Phone:505-222-0331
Practice Address - Fax:505-222-0365
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2789101YP2500X
NMM16161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical