Healthcare Provider Details

I. General information

NPI: 1235182007
Provider Name (Legal Business Name): LITTLE SUN S. HEARD L.P.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LITTLE SUN S. HEARD L.P.C.C.

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 2ND ST NW
ALBUQUERQUE NM
87107-4009
US

IV. Provider business mailing address

5100 2ND ST NW
ALBUQUERQUE NM
87107-4009
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-9437
  • Fax:
Mailing address:
  • Phone: 505-660-9437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC 0066492
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 3653
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: