Provider Demographics
NPI:1154704856
Name:TEMPLETON, LUANNE C (LPCC CRC)
Entity type:Individual
Prefix:
First Name:LUANNE
Middle Name:C
Last Name:TEMPLETON
Suffix:
Gender:F
Credentials:LPCC CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:BOSQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87006-0262
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:119 TELES ST SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8518
Practice Address - Country:US
Practice Address - Phone:505-865-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0172381101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health