Healthcare Provider Details

I. General information

NPI: 1467059428
Provider Name (Legal Business Name): DANIELLE LORRAINE LENZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 COMANCHE RD NE STE 22
ALBUQUERQUE NM
87107-4546
US

IV. Provider business mailing address

3 TIERRA DENTRO CT
LOS LUNAS NM
87031-9196
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-7608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2024-0294
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: