Healthcare Provider Details

I. General information

NPI: 1619703725
Provider Name (Legal Business Name): HERB LEMKE LMFT, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/14/2024
Certification Date: 09/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12358 LA CROSSE STREET
WHITE SANDS MISSILE RANGE NM
88002
US

IV. Provider business mailing address

12358 LA CROSSE STREET
WHITE SANDS MISSILE RANGE NM
88002
US

V. Phone/Fax

Practice location:
  • Phone: 919-352-2726
  • Fax:
Mailing address:
  • Phone: 919-352-2726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLH61381761
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2362
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: