MEDICARE: SOPHIA LOYA PEDRAZA LMHC/LSAA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0174321	NM
2	101YM0800X	Mental Health Counselor	0174431	NM

General Provider Information

NPI Number	:	1609246891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA LOYA PEDRAZA LMHC/LSAA

Provider Business Mailing Address
First Line	:	3850 FOOTHILLS RD
Second Line	:	STE #8
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4632
Country	:	US
Telephone Number	:	915-356-4629
Fax Number	:	575-815-7016

Provider Business Practice Location Address
First Line	:	3850 FOOTHILLS RD
Second Line	:	STE #8
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4632
Country	:	US
Telephone Number	:	915-356-4629
Fax Number	:	575-815-7016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	09/30/2015

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