Healthcare Provider Details

I. General information

NPI: 1225835044
Provider Name (Legal Business Name): LARRY ELISEO LOVATO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 INDIAN SCHOOL RD NE STE 200
ALBUQUERQUE NM
87110-4082
US

IV. Provider business mailing address

1016 SWALLOW DR SW
ALBUQUERQUE NM
87121-8186
US

V. Phone/Fax

Practice location:
  • Phone: 505-657-4161
  • Fax:
Mailing address:
  • Phone: 505-604-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: