Provider Demographics
NPI:1558671081
Name:LOUGHEAD, LIANA ALEXIS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LIANA
Middle Name:ALEXIS
Last Name:LOUGHEAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 OSUNA RD. NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-261-1755
Mailing Address - Fax:505-508-2584
Practice Address - Street 1:5712 OSUNA RD. NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-508-1470
Practice Address - Fax:505-508-2584
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-074541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMM-07454OtherNM STATE LICENSE