Provider Demographics
NPI:1942498456
Name:BUBAR, RHODA W (MA,LPCC)
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:W
Last Name:BUBAR
Suffix:
Gender:F
Credentials:MA,LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 GRANGE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3517
Mailing Address - Country:US
Mailing Address - Phone:505-792-4714
Mailing Address - Fax:
Practice Address - Street 1:7000 GRANGE AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3517
Practice Address - Country:US
Practice Address - Phone:505-792-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM#1788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health