Provider Demographics
NPI:1487082343
Name:PFEIFFER, CHAD SINCLAIR (LPCC)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:SINCLAIR
Last Name:PFEIFFER
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9620 ENTRADA VISTA AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1764
Mailing Address - Country:US
Mailing Address - Phone:505-514-4841
Mailing Address - Fax:
Practice Address - Street 1:6349 US HIGHWAY 550
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NM
Practice Address - Zip Code:87013-6032
Practice Address - Country:US
Practice Address - Phone:505-820-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0187641101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM29026849Medicaid