Provider Demographics
NPI:1053460808
Name:PATNAUDE, RICHARD LEWIS (LPCC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEWIS
Last Name:PATNAUDE
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12056 STATE HIGHWAY 14 N
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9405
Mailing Address - Country:US
Mailing Address - Phone:505-228-6343
Mailing Address - Fax:505-286-6112
Practice Address - Street 1:12126 STATE HIGHWAY 14 N STE E
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9406
Practice Address - Country:US
Practice Address - Phone:505-286-6112
Practice Address - Fax:505-286-6112
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0085791101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM22521542Medicaid