1447427083 NPI number — DOROTHY M WEEKS LPC

Table of content: DOROTHY M WEEKS LPC (NPI 1447427083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447427083 NPI number — DOROTHY M WEEKS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEEKS
Provider First Name:
DOROTHY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447427083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O.B 358
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PLATA
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87418-4559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
168-235-1142
Provider Business Mailing Address Fax Number:
168-235-1142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1195 COUNTY RD 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HESPERUS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
168-235-1142
Provider Business Practice Location Address Fax Number:
168-235-1142
Provider Enumeration Date:
05/13/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0098681 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)