Healthcare Provider Details

I. General information

NPI: 1386003630
Provider Name (Legal Business Name): LYLE REECE LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 SPAIN RD NE SUITE 106
ALBUQUERQUE NM
87109-3179
US

IV. Provider business mailing address

8205 SPAIN RD NE SUITE 106
ALBUQUERQUE NM
87109-3179
US

V. Phone/Fax

Practice location:
  • Phone: 505-856-0300
  • Fax: 505-856-7900
Mailing address:
  • Phone: 505-856-0300
  • Fax: 505-856-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0178901
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: