Provider Demographics
NPI:1831529411
Name:LORI A. WILLINGHURST, MD, LLC
Entity type:Organization
Organization Name:LORI A. WILLINGHURST, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLINGHURST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-688-4598
Mailing Address - Street 1:4810 HARDWARE DR NE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2013
Mailing Address - Country:US
Mailing Address - Phone:505-688-4598
Mailing Address - Fax:
Practice Address - Street 1:4810 HARDWARE DR NE
Practice Address - Street 2:SUITE #5
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2013
Practice Address - Country:US
Practice Address - Phone:505-688-4598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM98199261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health