Individual
LISA LANDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
720 E HACIENDA ST, ESPANOLA, NM 87532-2523
(505) 753-6769
Mailing address
3225 CALLE CELESTIAL, SANTA FE, NM 87506-1213
(505) 980-1990
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1114
NM
Other
Enumeration date
01/15/2010
Last updated
01/15/2010
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