Provider Demographics
NPI:1720136864
Name:VETTERMAN, DEBRA (LPCC, LPAT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:VETTERMAN
Suffix:
Gender:F
Credentials:LPCC, LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINAIR
Mailing Address - State:NM
Mailing Address - Zip Code:87036-0622
Mailing Address - Country:US
Mailing Address - Phone:505-265-2006
Mailing Address - Fax:505-847-0681
Practice Address - Street 1:127 BRYN MAWR DR SE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2265
Practice Address - Country:US
Practice Address - Phone:505-265-2006
Practice Address - Fax:505-847-0681
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLPCC#1753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA1965Medicaid
NM8772304Medicaid
NM81200722Medicaid