Healthcare Provider Details

I. General information

NPI: 1598438491
Provider Name (Legal Business Name): LANCE LASHLEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 HARKLE RD STE E
SANTA FE NM
87505-4765
US

IV. Provider business mailing address

122 MORADA LN UNIT 2
TAOS NM
87571-6893
US

V. Phone/Fax

Practice location:
  • Phone: 505-955-9454
  • Fax: 505-216-9067
Mailing address:
  • Phone: 678-334-6879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-12181
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number095400
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: