Provider Demographics
NPI:1104159466
Name:STAFFORD, PATRICK HARRY (LPCC)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:HARRY
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 VISTA DEL REY DR
Mailing Address - Street 2:
Mailing Address - City:VADO
Mailing Address - State:NM
Mailing Address - Zip Code:88072-7236
Mailing Address - Country:US
Mailing Address - Phone:575-233-3240
Mailing Address - Fax:
Practice Address - Street 1:220 VISTA DEL REY DR
Practice Address - Street 2:
Practice Address - City:VADO
Practice Address - State:NM
Practice Address - Zip Code:88072-7236
Practice Address - Country:US
Practice Address - Phone:575-233-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0096381101YM0800X
TX134501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health