Healthcare Provider Details

I. General information

NPI: 1013192707
Provider Name (Legal Business Name): RONALD LEE ANDES LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2008
Last Update Date: 01/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 RIDGECREST DR
SANTA FE NM
87505-6343
US

IV. Provider business mailing address

138 RIDGECREST DR
SANTA FE NM
87505-6343
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-9154
  • Fax: 505-438-9592
Mailing address:
  • Phone: 505-471-9154
  • Fax: 505-438-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC0915
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: