Provider Demographics
NPI:1679786743
Name:THUNDERCHIEF, WILHELMINA (LPCC)
Entity Type:Individual
Prefix:
First Name:WILHELMINA
Middle Name:
Last Name:THUNDERCHIEF
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 1:13170 CENTRAL AVE SE STE B
Mailing Address - Street 2:STE 129
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-5588
Mailing Address - Country:US
Mailing Address - Phone:505-346-9428
Mailing Address - Fax:
Practice Address - Street 1:2403 SAN MATEO BLVD NE
Practice Address - Street 2:SUITE W11B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4058
Practice Address - Country:US
Practice Address - Phone:505-232-3000
Practice Address - Fax:505-232-3006
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0082511101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional