Provider Demographics
NPI:1528263951
Name:ADAMS, LANCE ORNE (MA)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:ORNE
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:LANCE
Other - Last Name:ORNE-ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1279
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-1279
Mailing Address - Country:US
Mailing Address - Phone:505-463-6506
Mailing Address - Fax:
Practice Address - Street 1:11811 MENAUL BLVD NE
Practice Address - Street 2:208
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1788
Practice Address - Country:US
Practice Address - Phone:505-463-6506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist