Provider Demographics
NPI:1912201161
Name:CHABOT, KATHLEEN LUELLEN (LPCC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:LUELLEN
Last Name:CHABOT
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 1:4608 ALMERIA DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1840
Mailing Address - Country:US
Mailing Address - Phone:505-934-0934
Mailing Address - Fax:
Practice Address - Street 1:6666 4TH ST NW
Practice Address - Street 2:SUITE D
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6144
Practice Address - Country:US
Practice Address - Phone:505-934-0934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1498101YP2500X
NM0141941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional