Provider Demographics
NPI:1871748707
Name:EHARDT, DEVON ANN
Entity type:Individual
Prefix:MS
First Name:DEVON
Middle Name:ANN
Last Name:EHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 ACADEMY RD NE
Mailing Address - Street 2:APT #1235
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7245
Mailing Address - Country:US
Mailing Address - Phone:908-531-0067
Mailing Address - Fax:
Practice Address - Street 1:12200 ACADEMY RD NE
Practice Address - Street 2:APT #1235
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-7245
Practice Address - Country:US
Practice Address - Phone:908-531-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM331759101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool