Individual
WAYNE FAVREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
1302 CALLE DE LA MERCED, ESPANOLA, NM 87532-2624
(505) 747-0081
Mailing address
2551 COORS BLVD NW, ALBUQUERQUE, NM 87120-1213
(505) 338-3320
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0100411
NM
101YP2500X
Professional Counselor
Primary
0100411
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XXXXXXX
—
NM
Enumeration date
10/12/2006
Last updated
10/15/2015
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