Healthcare Provider Details

I. General information

NPI: 1659653103
Provider Name (Legal Business Name): TERA NICOLE UHL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2011
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S MAIN ST
LAS CRUCES NM
88001-1266
US

IV. Provider business mailing address

385 CALLE DE ALEGRA STE A
LAS CRUCES NM
88005-3423
US

V. Phone/Fax

Practice location:
  • Phone: 575-647-2841
  • Fax: 575-647-2898
Mailing address:
  • Phone: 575-526-1105
  • Fax: 575-524-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0173041
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: