Provider Demographics
NPI:1255764262
Name:HERRERA, LARRY (LADAC)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:HERRERA
Suffix:
Gender:M
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 CRUZ ALTA RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5947
Mailing Address - Country:US
Mailing Address - Phone:575-737-5533
Mailing Address - Fax:575-737-5534
Practice Address - Street 1:224 CRUZ ALTA ROAD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:575-737-5533
Practice Address - Fax:575-737-5534
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0161971101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)