1699861542 NPI number — SUSAN LEE VOIGT MA ATR BC LPAT LPCC

Table of content: SUSAN LEE VOIGT MA ATR BC LPAT LPCC (NPI 1699861542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699861542 NPI number — SUSAN LEE VOIGT MA ATR BC LPAT LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOIGT
Provider First Name:
SUSAN
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA ATR BC LPAT LPCC
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:
1699861542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W 1ST
Provider Second Line Business Mailing Address:
STE 532
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-627-0439
Provider Business Mailing Address Fax Number:
505-622-2750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W 1ST
Provider Second Line Business Practice Location Address:
STE 532
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-627-0439
Provider Business Practice Location Address Fax Number:
505-622-2750
Provider Enumeration Date:
10/05/2006

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: 221700000X , with the licence number:  2756 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 221700000X , with the licence number: 99003 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 0085801 , 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)

  • Identifier: NM202636 . This is a "VALUE OPTIONS MEDICAID" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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