Provider Demographics
NPI:1609270834
Name:RYAN, LORENE (LPCC)
Entity Type:Individual
Prefix:
First Name:LORENE
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:LORENE
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHANGED DUE MARRIAGE
Mailing Address - Street 1:6121 INDIAN SCHOOL RD NE STE 141
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3176
Mailing Address - Country:US
Mailing Address - Phone:505-888-1362
Mailing Address - Fax:
Practice Address - Street 1:6612 GULTON CT NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4407
Practice Address - Country:US
Practice Address - Phone:505-888-1686
Practice Address - Fax:505-888-1683
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0183461101YM0800X
NMCCMH0183461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03851834Medicaid