Doctor Name: | EMILY SUZANNA LUCERO-DELEON |
NPI Number: | 1063660686 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CAC III |
License Number: | 6324 |
Business Practice Address: | 302 Barnes Ave La Junta, CO - 810501329 |
Business Phone Number: | 7193848503 |
Business Fax Number: | 7193848411 |
Mailing Address: | 711 Barnes Ave, LA JUNTA |
State: | CO |
Postal Code: | 810502138 |
Phone Number: | 7193845446 |
Fax Number: | 7193845672 |
NPI Enumeration Date: | 09/08/2008 |
NPI Last Update Date: | 09/08/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 6324 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |