Provider Demographics
NPI:1710212006
Name:VANLENT, PETER COSBY (LSAA)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:COSBY
Last Name:VANLENT
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:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:CHIMAYO
Mailing Address - State:NM
Mailing Address - Zip Code:87522-0757
Mailing Address - Country:US
Mailing Address - Phone:505-351-0900
Mailing Address - Fax:
Practice Address - Street 1:1 JOHN HYSON DR. BLD 4,5,6
Practice Address - Street 2:
Practice Address - City:CHIMAYO
Practice Address - State:NM
Practice Address - Zip Code:87522-0757
Practice Address - Country:US
Practice Address - Phone:505-351-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM005938101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)