Healthcare Provider Details

I. General information

NPI: 1053631697
Provider Name (Legal Business Name): ROZELL COUNSELING AND PSYCHOTHERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2010
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 HOLLY AVE NE BLDG 4, SUITE F
ALBUQUERQUE NM
87122-2968
US

IV. Provider business mailing address

9400 HOLLY AVE NE BLDG 4, SUITE F
ALBUQUERQUE NM
87122-2968
US

V. Phone/Fax

Practice location:
  • Phone: 505-974-0329
  • Fax: 505-944-1073
Mailing address:
  • Phone: 505-974-0329
  • Fax: 505-944-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC-0132241
License Number StateNM

VIII. Authorized Official

Name: MS. REBECCA MACATEE ROZELL
Title or Position: CLINICAL COUNSELOR/PSYCHOTHERAPIST
Credential: LPCC, LADAC
Phone: 505-974-0329