Healthcare Provider Details

I. General information

NPI: 1073695235
Provider Name (Legal Business Name): JACK LEHMAN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CAMINO DE LAS MINAS
SANTA FE NM
87508-9475
US

IV. Provider business mailing address

14 CAMINO DE LAS MINAS
SANTA FE NM
87508-9475
US

V. Phone/Fax

Practice location:
  • Phone: 505-995-8200
  • Fax: 505-995-8200
Mailing address:
  • Phone: 505-995-8200
  • Fax: 505-995-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006192
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: