Provider Demographics
NPI:1740654391
Name:SERGIO A LOYA
Entity type:Organization
Organization Name:SERGIO A LOYA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPCC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-929-0554
Mailing Address - Street 1:5300 MCNUTT RD
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9606
Mailing Address - Country:US
Mailing Address - Phone:915-929-0554
Mailing Address - Fax:
Practice Address - Street 1:5300 MCNUTT RD
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9606
Practice Address - Country:US
Practice Address - Phone:915-929-0554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0158051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1548594559OtherNPI TYPE 1
NM70782024Medicaid