Lawrence Elden Dettweiler, PH.D.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

4706 Issued in NM

Practice address

453 Cerrillos Rd
Santa Fe, NM 87501-3784

Phone

(505) 603-0641

NPI assigned

Apr 9, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 1971

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Labyrinth LLC

  • Mental Health Counselor
  • Santa Fe, NM
  • NPI 1972626463
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407979990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MELADO DR",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875082254",
            "telephone_number": "505-603-0641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "453 CERRILLOS RD",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875013784",
            "telephone_number": "505-603-0641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTWEILER",
        "first_name": "LAWRENCE",
        "middle_name": "ELDEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "4706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12452777",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "VNM01398",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judy Deshaw
• Laurie Mae Grant Desilvera
• Sherry Beth Destromp, LPN
• Davina Rose Detrik, DDS
• Janine Cheryl Detter
• Amy Elizabeth Deupree
• Jerome Deutsch, MS, LN
• Devin Giron, DDS
• Daniel Devito
• Neal N Devitt, MD

• Mental Health Counselor in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Mental Health Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.