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Organization
LISA DYKES-HARRELL, LLC
Active
Organization
LISA DYKES-HARRELL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA L. DYKES-HARRELL LPCC (COUNSELOR)
(575) 749-3736
Entity
Organization
Contact information
Practice address
100 S AVE A, PORTALES, NM 88130-5917
(575) 749-3736
(575) 226-6892
Mailing address
187 NM 88, PORTALES, NM 88130
(575) 749-3736
(575) 226-6892
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
005790
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04850041
—
NM
01
—
11783765
CAQH
NM
01
—
1316956923
SOLE PROPRIETER NPI 1316956923
NM
Enumeration date
03/08/2011
Last updated
06/19/2012
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