Provider Demographics
NPI:1285697961
Name:DAHLSTEDT, CATHY GRACE (RN,C/ LPCC)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:GRACE
Last Name:DAHLSTEDT
Suffix:
Gender:F
Credentials:RN,C/ LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 PEARL DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4547
Mailing Address - Country:US
Mailing Address - Phone:505-891-8513
Mailing Address - Fax:
Practice Address - Street 1:2600 MARBLE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-1991
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2441101YM0800X
NMR14833163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult