Most Relevant Information
Provider Data
| NPI Number: | 1003489329 |
| Provider Name: | LAKASEY MONDRAGON BT |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/23/2021 |
| Last Updated: | 07/23/2021 |
Provider Practice Location
201 E LLANO ESTACADO BLVD
CLOVIS
NM
881013708
Practice Location Phone/Fax
| Phone: | 5757639517 |
| Fax: | 5757422369 |
Provider Mailing Location
1350 HILLRISE CIR
LAS CRUCES
NM
880114759
Provider Mailing Phone/Fax
| Phone: | 5755229500 |
| Fax: | 5756524163 |