Healthcare Provider Details

I. General information

NPI: 1881007284
Provider Name (Legal Business Name): DANIEL HARRIS FLORES LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW SUITE 1200
ALBUQUERQUE NM
87102-5340
US

IV. Provider business mailing address

500 MARQUETTE AVE NW SUITE 1200
ALBUQUERQUE NM
87102-5340
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-4835
  • Fax:
Mailing address:
  • Phone: 505-503-4835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0178771
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: