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General NPI Number Information
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NPI Number | 1366594020
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Entity Type | Individual
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Provider Name | LLOYD D VIGIL PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 1335 GUSDORF ROAD BUILDING E
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City | TAOS
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State | NM
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Zip | 87571
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Country | US
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Telephone | 575-758-0670
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Fax | 575-751-3557
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Provider Business Mailing Address
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Address Line | PO BOX 103
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City | CHIMAYO
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State | NM
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Zip | 87522-0103
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Country | US
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Telephone | 505-692-3170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2168
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 267076
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License Number State | NM
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