Healthcare Provider Details

I. General information

NPI: 1033505763
Provider Name (Legal Business Name): SAM NEWMON MA, LPCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320-H OSUNA RD NE SUITE 4
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

647 CALLE DE BLAS
CORRALES NM
87048-5105
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-2778
  • Fax: 505-345-2878
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0171811
License Number StateNM

VIII. Authorized Official

Name: MR. SAM NEWMON
Title or Position: OWNER
Credential: LPCC
Phone: 505-350-3027