Basic Information
| Provider Information | |||||||||
| NPI: | 1144565359 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELUCA | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | TARYN | ||||||||
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| Credential: | LMHC, LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1503 UNIVERSITY BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871021708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052432551 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1503 UNIVERSITY BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871021708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052432551 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2012 | ||||||||
| LastUpdateDate: | 12/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0127081 | NM | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | T-0155301 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.