Basic Information
| Provider Information | |||||||||
| NPI: | 1821148255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALBERT | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | KAYLENE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 E SANTA FE AVE | ||||||||
| Address2: | |||||||||
| City: | GRANTS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870202404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058761890 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 210 E SANTA FE AVE | ||||||||
| Address2: | |||||||||
| City: | GRANTS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870202404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058761890 | ||||||||
| FaxNumber: | 5058761886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0094021 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.