Provider Demographics
NPI:1780949115
Name:LASHWAY, AMY ANNA (LPCC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ANNA
Last Name:LASHWAY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 JORNADA LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8261
Mailing Address - Country:US
Mailing Address - Phone:505-466-3710
Mailing Address - Fax:888-636-7582
Practice Address - Street 1:2209 MIGUEL CHAVEZ RD STE F
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7010
Practice Address - Country:US
Practice Address - Phone:505-388-2361
Practice Address - Fax:888-636-7582
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5450101YP2500X
NMCCMH0225041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42477751Medicaid