Patrick Harry Stafford, LPCC
Individual provider Active NPI Clinical Social Worker · Vado, NM
NPI 1104159466 · NPPES record last updated Sep 17, 2009
Key facts
- NPI
- 1104159466
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 13450 (TX)
- Practice address
- 220 Vista del Rey Dr
Vado, NM 88072-7236 - Phone
- (575) 233-3240
- NPI assigned
- Sep 17, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0096381 | NM | MD | Mental Health Counselor |
| 13450 | TX | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lactation Consutant on the Go LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 0096381 | NM | |
| Clinical Social Worker | 1041C0700X | 13450 | TX | Yes |
Addresses
Primary practice location
220 Vista del Rey Dr
Vado, NM 88072-7236
Mailing address
220 Vista del Rey Dr
Vado, NM 88072-7236
Phone (575) 233-3240
Other providers in Vado, NM
- Lactation Consutant on the Go LLC
- Teresa R Marquez
- Ivonne Olson Penuela
- Dario Saucedo
- Deborah Stafford
- Vanessa R Torres
All providers in Vado, NM · Clinical Social Worker in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.