Healthcare Provider Details

I. General information

NPI: 1659752228
Provider Name (Legal Business Name): CHELSEA RENEE LUCERO MS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHELSEA RENEE STOINSKI MS LMHC

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 8TH ST
LAS VEGAS NM
87701-4219
US

IV. Provider business mailing address

PO BOX 158
ESPANOLA NM
87532-0158
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-6788
  • Fax:
Mailing address:
  • Phone: 505-753-7218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0189981
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: