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General NPI Number Information
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NPI Number | 1992905301
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Entity Type | Individual
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Provider Name | LAURA L LANSRUD-LOPEZ LPCC, LPAT, ATR-BC
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Gender | Female
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 3600 CERRILLOS RD SUITE 714 F
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City | SANTA FE
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State | NM
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Zip | 87507-2612
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Country | US
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Telephone | 505-310-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 4751 ARROYO RISUENO
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City | SANTA FE
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State | NM
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Zip | 87507-4612
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Country | US
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Telephone | 505-310-2121
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0130401
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0127681
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License Number State | NM
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