Provider Demographics
NPI:1366594020
Name:VIGIL, LLOYD D (PHD)
Entity type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:D
Last Name:VIGIL
Suffix:
Gender:M
Credentials:PHD
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 103
Mailing Address - Street 2:
Mailing Address - City:CHIMAYO
Mailing Address - State:NM
Mailing Address - Zip Code:87522-0103
Mailing Address - Country:US
Mailing Address - Phone:505-692-3170
Mailing Address - Fax:
Practice Address - Street 1:1335 GUSDORF ROAD
Practice Address - Street 2:BUILDING E
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:575-758-0670
Practice Address - Fax:575-751-3557
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2168101YP2500X
NM267076103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool