Favreau, Wayne

Favreau, Wayne is an individual health care provider with primary practice located at 1302 Calle De La Merced , Espanola NM 87532-2624. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is his primary health care specialty. Favreau, Wayne can be contacted via phone (505) 747-0081.

Contact Information

Primary practice address
1302 Calle De La Merced Espanola NM 87532-2624
Phone: (505) 747-0081
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 0100411 New Mexico
Behavioral Health & Social Service Providers / Professional 101YP2500X 0100411 New Mexico

Profile Details

NPI number 1730278854
LBN Legal business name Favreau, Wayne
Credentials LPCC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 12th, 2006
Last updated Oct 15th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730278854 NPPES
New Mexico MEDICAID XXXXXXX

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