Provider Demographics
NPI:1225649015
Name:PACHECO, TAMI (BA, MA, LADC)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:BA, MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 RANCHO GRANDE PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5336
Mailing Address - Country:US
Mailing Address - Phone:505-401-4734
Mailing Address - Fax:
Practice Address - Street 1:8928 OPPORTUNITY DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5153
Practice Address - Country:US
Practice Address - Phone:505-401-4734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder