Healthcare Provider Details

I. General information

NPI: 1609270834
Provider Name (Legal Business Name): LORENE RYAN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORENE KING CHANGED DUE MARRIAGE

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6612 GULTON CT NE STE A
ALBUQUERQUE NM
87109-4407
US

IV. Provider business mailing address

6121 INDIAN SCHOOL RD NE STE 141
ALBUQUERQUE NM
87110-3176
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-1686
  • Fax: 505-888-1683
Mailing address:
  • Phone: 505-888-1362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0183461
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0183461
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: