Healthcare Provider Details

I. General information

NPI: 1184124349
Provider Name (Legal Business Name): LUCAS ARMON BOYER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 1ST ST
ALAMOGORDO NM
88310-6504
US

IV. Provider business mailing address

3551 FERNWOOD AVE
ALAMOGORDO NM
88310-5483
US

V. Phone/Fax

Practice location:
  • Phone: 575-572-5676
  • Fax:
Mailing address:
  • Phone: 208-598-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: