Individual provider Active NPI

Damien Derego, LMHC

  • Mental Health Counselor
  • Las Vegas, NM
National Provider Identifier
1003695156
Registry record updated Sep 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
CTB-2023-0759 Issued in NM
Practice address
1235 8TH St
Las Vegas, NM 87701-4219
Phone
(505) 426-6788
NPI assigned
Sep 27, 2023
Last updated
Sep 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X CTB-2023-0759 NM Primary

Addresses

Primary practice location

1235 8TH St
Las Vegas, NM 87701-4219

Mailing address

538 N Paseo de Onate
Espanola, NM 87532-2618
Phone (505) 753-7218

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CTB-2023-0759NMMDMental Health Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1003695156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 N PASEO DE ONATE",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875322618",
            "telephone_number": "505-753-7218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 8TH ST",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014219",
            "telephone_number": "505-426-6788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEREGO",
        "first_name": "DAMIEN",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-27",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CTB-2023-0759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.