Healthcare Provider Details

I. General information

NPI: 1659148724
Provider Name (Legal Business Name): ERIK MUNOZ LSAA, BSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 QUINCY ST NE
ALBUQUERQUE NM
87108-1257
US

IV. Provider business mailing address

146 QUINCY ST NE
ALBUQUERQUE NM
87108-1257
US

V. Phone/Fax

Practice location:
  • Phone: 505-907-3047
  • Fax:
Mailing address:
  • Phone: 505-550-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2023-0467
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: