Provider Demographics
NPI:1699013169
Name:PATRICIA MARTINEZ BURR, MA, LPCC, NCC
Entity Type:Organization
Organization Name:PATRICIA MARTINEZ BURR, MA, LPCC, NCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL CLINICAL COUN
Authorized Official - Prefix:
Authorized Official - First Name:PARICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ BURR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:505-463-0472
Mailing Address - Street 1:6666 4TH ST NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6144
Mailing Address - Country:US
Mailing Address - Phone:505-463-0472
Mailing Address - Fax:
Practice Address - Street 1:6666 4TH ST NW
Practice Address - Street 2:SUITE B
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6144
Practice Address - Country:US
Practice Address - Phone:505-463-0472
Practice Address - Fax:505-344-7581
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATRICIA MARTINEZ BURR, MA, LPCC, NCC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36171883Medicaid