Healthcare Provider Details

I. General information

NPI: 1992905301
Provider Name (Legal Business Name): LAURA L LANSRUD-LOPEZ LPCC, LPAT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. LAURA L LOPEZ

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CERRILLOS RD SUITE 714 F
SANTA FE NM
87507-2612
US

IV. Provider business mailing address

4751 ARROYO RISUENO
SANTA FE NM
87507-4612
US

V. Phone/Fax

Practice location:
  • Phone: 505-310-2121
  • Fax:
Mailing address:
  • Phone: 505-310-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0130401
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0127681
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: