Provider Demographics
NPI:1104952738
Name:PACKARD, ALONNA KAYE (BS)
Entity type:Individual
Prefix:
First Name:ALONNA
Middle Name:KAYE
Last Name:PACKARD
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 BELLEVIEW AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-3300
Mailing Address - Country:US
Mailing Address - Phone:719-251-2846
Mailing Address - Fax:
Practice Address - Street 1:711 BARNES AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2138
Practice Address - Country:US
Practice Address - Phone:719-384-5446
Practice Address - Fax:719-384-5672
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor