Provider Demographics
NPI:1194565481
Name:PACKER, LOU (LSAA)
Entity type:Individual
Prefix:
First Name:LOU
Middle Name:
Last Name:PACKER
Suffix:
Gender:M
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 WASHINGTON ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2930
Mailing Address - Country:US
Mailing Address - Phone:505-492-8440
Mailing Address - Fax:
Practice Address - Street 1:2131 LEAD AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4007
Practice Address - Country:US
Practice Address - Phone:505-895-0147
Practice Address - Fax:505-441-2954
Is Sole Proprietor?:No
Enumeration Date:2024-05-25
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0288101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)