Healthcare Provider Details

I. General information

NPI: 1760704654
Provider Name (Legal Business Name): REGINA LASELUTE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5408 LITO RD NW
ALBUQUERQUE NM
87114-5291
US

IV. Provider business mailing address

5408 LITO RD NW
ALBUQUERQUE NM
87114-5291
US

V. Phone/Fax

Practice location:
  • Phone: 505-417-4302
  • Fax:
Mailing address:
  • Phone: 505-417-4302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0087371
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: