Healthcare Provider Details

I. General information

NPI: 1942855671
Provider Name (Legal Business Name): DYLAN R KESTER LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 SAN GABRIEL ST
BERNALILLO NM
87004-5648
US

IV. Provider business mailing address

1207 SAN GABRIEL ST
BERNALILLO NM
87004-5648
US

V. Phone/Fax

Practice location:
  • Phone: 505-635-1980
  • Fax:
Mailing address:
  • Phone: 505-635-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSA0204901
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCTB-2025-0760
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: