Provider Demographics
NPI:1487057246
Name:ARCHULETA SR., LARRY STEVE SR (LICENSE ALCOHOL & DR)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:STEVE
Last Name:ARCHULETA SR.
Suffix:SR
Gender:M
Credentials:LICENSE ALCOHOL & DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8112 VISTA ESTRELLA LN. S.W
Mailing Address - Street 2:
Mailing Address - City:ALB.
Mailing Address - State:NM
Mailing Address - Zip Code:87121
Mailing Address - Country:US
Mailing Address - Phone:505-907-8699
Mailing Address - Fax:
Practice Address - Street 1:1611 CENTRAL NW
Practice Address - Street 2:
Practice Address - City:ALB.
Practice Address - State:NM
Practice Address - Zip Code:87104
Practice Address - Country:US
Practice Address - Phone:505-242-4622
Practice Address - Fax:505-247-1373
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3695101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)