Healthcare Provider Details

I. General information

NPI: 1821656000
Provider Name (Legal Business Name): ANDREW J CHIARALUCE LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 SIPAPU ST
TAOS NM
87571-6498
US

IV. Provider business mailing address

412 SIPAPU ST
TAOS NM
87571-6498
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-9513
  • Fax:
Mailing address:
  • Phone: 575-425-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0225211
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: