Healthcare Provider Details

I. General information

NPI: 1184781858
Provider Name (Legal Business Name): LINDA C. LECLAIRE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W APACHE ST
FARMINGTON NM
87401-5835
US

IV. Provider business mailing address

313 W APACHE ST
FARMINGTON NM
87401-5835
US

V. Phone/Fax

Practice location:
  • Phone: 505-325-5321
  • Fax: 505-325-6453
Mailing address:
  • Phone: 505-325-5321
  • Fax: 505-325-6453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1229
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: