Healthcare Provider Details

I. General information

NPI: 1629451646
Provider Name (Legal Business Name): JOHANNE M LEGER LPPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 CARLISLE BLVD NE STE E
ALBUQUERQUE NM
87107-4806
US

IV. Provider business mailing address

419 MONROE ST NE APT 2
ALBUQUERQUE NM
87108-1263
US

V. Phone/Fax

Practice location:
  • Phone: 505-401-7927
  • Fax:
Mailing address:
  • Phone: 505-401-7927
  • 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:
Title or Position:
Credential:
Phone: