Healthcare Provider Details

I. General information

NPI: 1659064517
Provider Name (Legal Business Name): LESLIE LUCERO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 OSUNA RD NE STE 209
ALBUQUERQUE NM
87107-5950
US

IV. Provider business mailing address

316 OSUNA RD NE STE 209
ALBUQUERQUE NM
87107-5950
US

V. Phone/Fax

Practice location:
  • Phone: 505-573-2619
  • Fax:
Mailing address:
  • Phone: 505-573-2619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2025-0719
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: