LEROY JIM LPCC CRC NPI 1063627354

NPI Information

NPI: 1063627354
Provider Name: LEROY JIM, LPCC, CRC
Classification: Counselor - 101YP2500X
Entity Type: Individual

Specialization: Professional

Address:
2025 E AZTEC AVE
GALLUP, NM
ZIP 87301
Phone: (505) 863-3828
Get Directions

Leroy Jim, LPCC, CRC is a professional counselor in Gallup, NM. Leroy Jim, LPCC, CRC NPI is 1063627354. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2025 E AZTEC AVE
GALLUP, NM
ZIP 87301-803
Phone: (505) 863-3828

The enumeration date for this NPI number is 5/11/2007 and was last updated on 6/15/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	225C00000X	Rehabilitation Counselor		00056257		No
2	101YP2500X	Counselor	Professional	0146941	NEW MEXICO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	76986063	MEDICAID	NEW MEXICO
2	43929842	MEDICAID	NEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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