Healthcare Provider Details

I. General information

NPI: 1154704856
Provider Name (Legal Business Name): LUANNE C TEMPLETON LPCC. CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 TELES ST SW
LOS LUNAS NM
87031-8518
US

IV. Provider business mailing address

PO BOX 262
BOSQUE NM
87006-0262
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0172381
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: