Healthcare Provider Details

I. General information

NPI: 1639155146
Provider Name (Legal Business Name): JOHN L RICH LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E FAIRVIEW LN
ESPANOLA NM
87532-2822
US

IV. Provider business mailing address

PO BOX 151
ABIQUIU NM
87510-0151
US

V. Phone/Fax

Practice location:
  • Phone: 505-747-1991
  • Fax:
Mailing address:
  • Phone: 505-747-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0088161
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0088161
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number0088161
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: