MEDICARE: DEANNA LASATER

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	101YP2500X	Professional Counselor
2	101YM0800X	Mental Health Counselor	0086031	NM

General Provider Information

NPI Number	:	1669838827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA LASATER

Provider Business Mailing Address
First Line	:	3232 CANDELARIA RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1907
Country	:	US
Telephone Number	:	505-323-3785
Fax Number	:

Provider Business Practice Location Address
First Line	:	428 LOS LENTES RD SE
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-6018
Country	:	US
Telephone Number	:	505-216-2727
Fax Number	:

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

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	01/09/2025

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Directions to “ DEANNA LASATER ” Practice Location

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