Healthcare Provider Details

I. General information

NPI: 1629384078
Provider Name (Legal Business Name): JAMES HATFIELD, LPCC, MA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 SUN RANCH VILLAGE LOOP SW
LOS LUNAS NM
87031-4869
US

IV. Provider business mailing address

PO BOX 3221
LOS LUNAS NM
87031-3221
US

V. Phone/Fax

Practice location:
  • Phone: 505-315-0240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number0093331
License Number StateNM

VIII. Authorized Official

Name: RENITA FREEMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 505-338-2055