Provider Demographics
NPI:1982817672
Name:LACUNA INC
Entity Type:Organization
Organization Name:LACUNA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OF LACUNA
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, ATR-BC
Authorized Official - Phone:505-751-3565
Mailing Address - Street 1:7479 NDCBU
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6177
Mailing Address - Country:US
Mailing Address - Phone:505-770-6713
Mailing Address - Fax:505-751-7231
Practice Address - Street 1:112 ALEXANDER ST # B
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6278
Practice Address - Country:US
Practice Address - Phone:505-770-6713
Practice Address - Fax:505-751-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM100657OtherVALUE OPTION PROVIDER NUM
NMA0211Medicaid