Basic Information
| Provider Information | |||||||||
| NPI: | 1205068921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | LENORE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | L.P.C.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1629 QUESTA RD NE | ||||||||
| Address2: | |||||||||
| City: | RIO RANCHO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871446324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054800251 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 707 BROADWAY BLVD NE | ||||||||
| Address2: | 401 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053458471 | ||||||||
| FaxNumber: | 5053425414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2009 | ||||||||
| LastUpdateDate: | 01/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0124491 | NM | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 0156851 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.