Provider Demographics
NPI:1679802300
Name:HODGES, ROBERT (LMHC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HODGES
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 CAMINO DEL REY CT SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6118
Mailing Address - Country:US
Mailing Address - Phone:505-865-7886
Mailing Address - Fax:
Practice Address - Street 1:40 HOB RD
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-7601
Practice Address - Country:US
Practice Address - Phone:505-865-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0127711101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor