Healthcare Provider Details

I. General information

NPI: 1578893483
Provider Name (Legal Business Name): DANIEL JAMES SALAZAR LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 GRIEGOS RD NW
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

1999 PANORAMA DRIVE
LOS LUNAS NM
87031
US

V. Phone/Fax

Practice location:
  • Phone: 505-342-5450
  • Fax:
Mailing address:
  • Phone: 505-400-7130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number0098571
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: