Healthcare Provider Details

I. General information

NPI: 1588045249
Provider Name (Legal Business Name): LISA R VAN MEIR LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5416 BLUE JAY LN NW
ALBUQUERQUE NM
87120-4915
US

IV. Provider business mailing address

5416 BLUE JAY LN NW
ALBUQUERQUE NM
87120-4915
US

V. Phone/Fax

Practice location:
  • Phone: 505-681-2640
  • 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
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0168061
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: