Provider Demographics
NPI:1316008618
Name:IRISH, KATHERINE (LPCC, LPAT)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:IRISH
Suffix:
Gender:F
Credentials:LPCC, LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-0037
Mailing Address - Country:US
Mailing Address - Phone:505-238-3520
Mailing Address - Fax:505-867-6283
Practice Address - Street 1:2929 COORS BLVD NW
Practice Address - Street 2:SUITE 201D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1173
Practice Address - Country:US
Practice Address - Phone:505-238-3520
Practice Address - Fax:505-867-6283
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5541101YM0800X
NM3296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18338267Medicaid
NM23029OtherLOVELACE SANDIA IHEALTH
NMNM100484OtherVALUE OPTIONS
NM1150415OtherCIGNA
NM00JN89OtherBLUE CROSS BLUE SHIELD
NM10006728OtherLOVELACE SANDIA IHEALTH
NM201014626OtherPRESBYTERNIAN HEALTH PLAN