Basic Information
| Provider Information | |||||||||
| NPI: | 1861855769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALBUJA | ||||||||
| FirstName: | PABLO | ||||||||
| MiddleName: | RUBEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3005 BRIGHTON PT | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729035477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4798313210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7217 CAMERON PARK DR | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729036167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4798316007 | ||||||||
| FaxNumber: | 4797821242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2016 | ||||||||
| LastUpdateDate: | 10/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | P1901010 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | A1603031 | AR | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.