Healthcare Provider Details

I. General information

NPI: 1144068958
Provider Name (Legal Business Name): AUGUSTUS JAMES ALTON MORRIS LSAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 CALLE CHAMISAL
ESPANOLA NM
87532-2976
US

IV. Provider business mailing address

601 MENAUL BLVD NE UNIT 4303
ALBUQUERQUE NM
87107-1534
US

V. Phone/Fax

Practice location:
  • Phone: 505-376-7287
  • Fax:
Mailing address:
  • Phone: 575-693-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2026-0491
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: