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General NPI Number Information
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NPI Number | 1881992311
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Entity Type | Organization
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Legal Business Name | LISA DYKES-HARRELL, LLC
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Dates
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Enumeration Date | 03/08/2011
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | 100 S AVE A
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City | PORTALES
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State | NM
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Zip | 88130-5917
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Country | US
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Telephone | 575-749-3736
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Fax | 575-226-6892
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Provider Business Mailing Address
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Address Line | 187 NM 88
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City | PORTALES
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State | NM
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Zip | 88130
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Country | US
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Telephone | 575-749-3736
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Fax | 575-226-6892
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Authorized Official
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Title or Position | COUNSELOR
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Name | MS. LISA L. DYKES-HARRELL
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Credential | LPCC
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Telephone | 575-749-3736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 005790
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License Number State | NM
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