Healthcare Provider Details

I. General information

NPI: 1891831608
Provider Name (Legal Business Name): JAMES MICHAEL MASICA LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 SAWMILL RD
BERNALILLO NM
87004-6553
US

IV. Provider business mailing address

1033 SAWMILL RD
BERNALILLO NM
87004-6553
US

V. Phone/Fax

Practice location:
  • Phone: 505-310-2371
  • Fax:
Mailing address:
  • Phone: 505-310-2371
  • Fax: 505-888-1683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0105301
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: