Provider Demographics
NPI:1588622203
Name:FITZCALLAGHAN, NIKI LYNN (RNCS,LPCC)
Entity Type:Individual
Prefix:
First Name:NIKI
Middle Name:LYNN
Last Name:FITZCALLAGHAN
Suffix:
Gender:F
Credentials:RNCS,LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CALLE ARCO
Mailing Address - Street 2:UNIT 2
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1033
Mailing Address - Country:US
Mailing Address - Phone:505-988-2922
Mailing Address - Fax:866-433-1440
Practice Address - Street 1:925 CALLE ARCO
Practice Address - Street 2:UNIT 2
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1033
Practice Address - Country:US
Practice Address - Phone:505-988-2922
Practice Address - Fax:866-433-1440
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR17832163WP0809X
NM1941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional