Provider Demographics
NPI:1992905301
Name:LANSRUD-LOPEZ, LAURA L (LPCC, LPAT, ATR-BC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:L
Last Name:LANSRUD-LOPEZ
Suffix:
Gender:F
Credentials:LPCC, LPAT, ATR-BC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:L
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4751 ARROYO RISUENO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4612
Mailing Address - Country:US
Mailing Address - Phone:505-310-2121
Mailing Address - Fax:
Practice Address - Street 1:3600 CERRILLOS RD
Practice Address - Street 2:SUITE 714 F
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2612
Practice Address - Country:US
Practice Address - Phone:505-310-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0130401101YM0800X
NM0127681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health