Healthcare Provider Details

I. General information

NPI: 1578295853
Provider Name (Legal Business Name): LOYCE STARKE LPCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 ADAMS ST SE STE C
ALBUQUERQUE NM
87108-2805
US

IV. Provider business mailing address

4934 KATHRYN CIR SE
ALBUQUERQUE NM
87108-3502
US

V. Phone/Fax

Practice location:
  • Phone: 505-489-9680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: FERNANDO ORTIZ
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 575-707-8150