Healthcare Provider Details

I. General information

NPI: 1407074438
Provider Name (Legal Business Name): JOE TERRAZAS LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E LOHMAN AVE STE B
LAS CRUCES NM
88001-3394
US

IV. Provider business mailing address

1300G EL PASEO RD STE 115
LAS CRUCES NM
88001-6024
US

V. Phone/Fax

Practice location:
  • Phone: 575-202-1719
  • Fax:
Mailing address:
  • Phone: 575-202-1719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0138771
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: