Provider Demographics
NPI:1992224117
Name:HODGES, KATHLEEN NANCY (LPCC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:NANCY
Last Name:HODGES
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 1:1772 BUCHANAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-8485
Mailing Address - Country:US
Mailing Address - Phone:575-635-0641
Mailing Address - Fax:
Practice Address - Street 1:1772 BUCHANAN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-8485
Practice Address - Country:US
Practice Address - Phone:575-635-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1707101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health