Provider Demographics
NPI:1033530928
Name:DEWHURST, LAURIE (LPCC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:DEWHURST
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16272
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87191-6272
Mailing Address - Country:US
Mailing Address - Phone:505-903-8480
Mailing Address - Fax:505-878-9999
Practice Address - Street 1:2920 CARLISLE BLVD NE STE 123H
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2884
Practice Address - Country:US
Practice Address - Phone:505-903-8480
Practice Address - Fax:505-878-9999
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0186371101YP2500X, 101YM0800X
NM0162181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03129268Medicaid