Healthcare Provider Details

I. General information

NPI: 1902828106
Provider Name (Legal Business Name): JOHN AYER LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 CERRILLOS RD
SANTA FE NM
87501-2636
US

IV. Provider business mailing address

1317 LUANA ST STUDIO
SANTA FE NM
87505-3238
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-5111
  • Fax:
Mailing address:
  • Phone: 505-699-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0091271
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: