Provider Demographics
NPI:1326106360
Name:HIESTER, RICHARD B (MA, LPCC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:B
Last Name:HIESTER
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:B
Other - Last Name:HIESTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LPCC
Mailing Address - Street 1:4308 CARLISLE BLVD NE, STE 210
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4849
Mailing Address - Country:US
Mailing Address - Phone:505-247-1921
Mailing Address - Fax:505-247-1020
Practice Address - Street 1:4308 CARLISLE BLVD NE, STE 210
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4849
Practice Address - Country:US
Practice Address - Phone:505-247-1921
Practice Address - Fax:505-247-1020
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NMCCMH1706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78523362Medicaid