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General NPI Number Information
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NPI Number | 1215254909
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Entity Type | Organization
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Legal Business Name | COHERENT LEARNING SYSTEMS, LLC
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Dates
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Enumeration Date | 04/21/2010
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Last Update Date | 04/21/2010
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Provider Practice Location Address
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Address Line | 10601 LOMAS BLVD NE STE 108
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-5462
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Country | US
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Telephone | 505-259-9100
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Fax | 505-856-9600
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Provider Business Mailing Address
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Address Line | 10601 LOMAS BLVD NE STE 108
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-5462
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Country | US
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Telephone | 505-259-9100
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Fax | 505-856-9600
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Authorized Official
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Title or Position | MANAGER
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Name | MR. CARLTON W LEWIS
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Credential | M.A. LPCC LADAC
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Telephone | 505-259-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0092471
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0122291
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License Number State | NM
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