Provider Demographics
NPI:1942546767
Name:WIGGINS, KATHRYN TORBUSH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:TORBUSH
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 CIELO VISTA DEL SUR
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-8911
Mailing Address - Country:US
Mailing Address - Phone:505-385-1394
Mailing Address - Fax:
Practice Address - Street 1:552 AGUA FRIA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2508
Practice Address - Country:US
Practice Address - Phone:505-982-3113
Practice Address - Fax:505-982-2462
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1249103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth