Healthcare Provider Details

I. General information

NPI: 1720313927
Provider Name (Legal Business Name): DAVID RICHARD LITTLE LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8338 COMANCHE RD NE STE B
ALBUQUERQUE NM
87110-2357
US

IV. Provider business mailing address

8338 COMANCHE RD NE STE B
ALBUQUERQUE NM
87110-2357
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-3665
  • Fax: 505-323-1038
Mailing address:
  • Phone: 505-323-3665
  • Fax: 505-323-1038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0125711
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: