Healthcare Provider Details

I. General information

NPI: 1780949115
Provider Name (Legal Business Name): AMY ANNA LASHWAY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 MIGUEL CHAVEZ RD STE F
SANTA FE NM
87505-7010
US

IV. Provider business mailing address

7 JORNADA LOOP
SANTA FE NM
87508-8261
US

V. Phone/Fax

Practice location:
  • Phone: 505-388-2361
  • Fax: 888-636-7582
Mailing address:
  • Phone: 505-466-3710
  • Fax: 888-636-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5450
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0225041
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: