Healthcare Provider Details

I. General information

NPI: 1740260066
Provider Name (Legal Business Name): JAMES E HERRERA LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ALAMO AVE SE
ALBUQUERQUE NM
87106-3204
US

IV. Provider business mailing address

904 CALIFORNIA ST SE
ALBUQUERQUE NM
87108-4912
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-2414
  • Fax: 505-925-2411
Mailing address:
  • Phone: 505-255-1283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4227
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: