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NPI Code Detail

MEDICARE: CHRISTINA RENEE LAVAIL

MEDICARE:   CHRISTINA RENEE LAVAIL
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
1101YM0800XMental Health Counselor0131051NM
2101YM0800XMental Health CounselorT-0122831NM
3106H00000XMarriage & Family TherapistCMF0140161NM

General Provider Information

NPI Number : 1639315021
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA RENEE LAVAIL
Provider Business Mailing Address
First Line : PO BOX 45681
Second Line :
City : RIO RANCHO
State : NM
Zip : 87174-5681
Country : US
Telephone Number : 505-226-1960
Fax Number : 505-672-7769
Provider Business Practice Location Address
First Line : 4801 LANG AVE NE
Second Line : UNIT 110
City : ALBUQUERQUE
State : NM
Zip : 87109-4475
Country : US
Telephone Number : 505-705-1701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2009
Last Update Date : 04/08/2021

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Directions to “ CHRISTINA RENEE LAVAIL ” Practice Location

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