Provider Demographics
NPI:1033990296
Name:TERRAZAS, MIGUEL A (LSAA)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:TERRAZAS
Suffix:
Gender:M
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 MALL DR STE E
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8194
Mailing Address - Country:US
Mailing Address - Phone:575-522-0660
Mailing Address - Fax:
Practice Address - Street 1:1141 MALL DR STE E
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8194
Practice Address - Country:US
Practice Address - Phone:575-522-0660
Practice Address - Fax:575-522-3151
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0826101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)