Provider Demographics
NPI:1497980312
Name:ROMBACH, LAURA LYNN (LPCC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:ROMBACH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:1001 YALE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3825
Practice Address - Country:US
Practice Address - Phone:505-272-2890
Practice Address - Fax:505-272-1943
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3205101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health