Healthcare Provider Details

I. General information

NPI: 1497410088
Provider Name (Legal Business Name): LAMAR GUNTER RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 JEFFERSON ST NE
ALBUQUERQUE NM
87113-1733
US

IV. Provider business mailing address

8300 JEFFERSON ST NE
ALBUQUERQUE NM
87113-1733
US

V. Phone/Fax

Practice location:
  • Phone: 877-743-6506
  • Fax:
Mailing address:
  • Phone: 844-743-6506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number1-17-28100
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number740430
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: