Healthcare Provider Details

I. General information

NPI: 1669838827
Provider Name (Legal Business Name): DEANNA LASATER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 LOS LENTES RD SE
LOS LUNAS NM
87031-6018
US

IV. Provider business mailing address

3232 CANDELARIA RD NE
ALBUQUERQUE NM
87107-1907
US

V. Phone/Fax

Practice location:
  • Phone: 505-216-2727
  • Fax:
Mailing address:
  • Phone: 505-323-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0086031
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: