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NPI Code Detail

MEDICARE: MR. TRENT LAMAR JOHN L.P.C.C.

MEDICARE: MR. TRENT LAMAR JOHN L.P.C.C.
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
1101YP2500XProfessional CounselorCCMH013001NM

General Provider Information

NPI Number : 1134105380
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TRENT LAMAR JOHN L.P.C.C.
Provider Business Mailing Address
First Line : 105 SUGAR RIDGE LOOP SE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87124-4312
Country : US
Telephone Number : 505-796-2356
Fax Number :
Provider Business Practice Location Address
First Line : 4011 BARBARA LOOP SE STE 206A
Second Line :
City : RIO RANCHO
State : NM
Zip : 87124-1041
Country : US
Telephone Number : 505-796-2356
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2005
Last Update Date : 01/06/2025

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