MEDICARE: KRISTIN LICHTLE LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	CTB-2023-0733	NM

General Provider Information

NPI Number	:	1043640493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN LICHTLE LPCC

Provider Business Mailing Address
First Line	:	3825 MONTGOMERY BLVD NE APT 121
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-1007
Country	:	US
Telephone Number	:	505-588-8207
Fax Number	:

Provider Business Practice Location Address
First Line	:	4004 CARLISLE BLVD NE STE G
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4566
Country	:	US
Telephone Number	:	505-588-8207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2013
Last Update Date	:	10/03/2024

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