Individual
LISA CLUGSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
4686 CORRALES RD STE 4E, CORRALES, NM 87048-8658
(505) 238-6420
Mailing address
66 GRIEGO CT, CORRALES, NM 87048-6500
(505) 238-6420
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0142491
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92189873
—
NM
Enumeration date
08/25/2007
Last updated
03/08/2012
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