Provider Demographics
NPI:1134105380
Name:JOHN, TRENT LAMAR (LPCC)
Entity type:Individual
Prefix:MR
First Name:TRENT
Middle Name:LAMAR
Last Name:JOHN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SUGAR RIDGE LOOP SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4312
Mailing Address - Country:US
Mailing Address - Phone:505-796-2356
Mailing Address - Fax:
Practice Address - Street 1:4011 BARBARA LOOP SE STE 206A
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1041
Practice Address - Country:US
Practice Address - Phone:505-796-2356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH013001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107032315101OtherINTERMOUNTAIN HEALTHCARE
UTNPP000Medicare UPIN