Basic Information
| Provider Information | |||||||||
| NPI: | 1609245760 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TROPE | ||||||||
| FirstName: | ETHAN | ||||||||
| MiddleName: | VOORHEES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 PERKINS DR STE B | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880053248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755266682 | ||||||||
| FaxNumber: | 5755237254 | ||||||||
| Practice Location | |||||||||
| Address1: | 1675 HICKORY LOOP | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880056587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756523155 | ||||||||
| FaxNumber: | 5057154958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2015 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | T610236853187 | MI | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 103K00000X | 1-20-42415 | NM | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.