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General NPI Number Information
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NPI Number | 1407652233
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Entity Type | Organization
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Legal Business Name | VLC III, LLC
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 2019 GALISTEO ST
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City | SANTA FE
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State | NM
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Zip | 87505-2143
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Country | US
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Telephone | 505-477-1138
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Fax | 575-288-2211
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Provider Business Mailing Address
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Address Line | 5658 1/2 MAIN ST
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City | SYLVANIA
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State | OH
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Zip | 43560-1928
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Country | US
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Telephone | 505-365-3202
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Fax | 419-243-0221
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Authorized Official
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Title or Position | PRESIDENT
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Name | LUCAS J NACHTRAB
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Credential |
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Telephone | 505-365-3202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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