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NPI Code Detail

MEDICARE: LAMARR D. EDGERSON LMFT

MEDICARE:   LAMARR D. EDGERSON  LMFT
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
1106H00000XMarriage & Family Therapist0112671NM

General Provider Information

NPI Number : 1598889552
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAMARR D. EDGERSON LMFT
Provider Business Mailing Address
First Line : 8044 WATERBURY AVE NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87120-5525
Country : US
Telephone Number : 505-629-1590
Fax Number :
Provider Business Practice Location Address
First Line : 7001 PROSPECT PL NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87110-4311
Country : US
Telephone Number : 505-629-1590
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 06/19/2009

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Directions to “ LAMARR D. EDGERSON LMFT” Practice Location

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