Healthcare Provider Details

I. General information

NPI: 1508506809
Provider Name (Legal Business Name): LAVEDA TSOSIE LSAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 W ARRINGTON ST
FARMINGTON NM
87401-8513
US

IV. Provider business mailing address

653 W ARRINGTON ST
FARMINGTON NM
87401-8513
US

V. Phone/Fax

Practice location:
  • Phone: 505-564-3733
  • Fax:
Mailing address:
  • Phone: 505-327-4584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSA0210331
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCSA0210331
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: