Healthcare Provider Details

I. General information

NPI: 1114213246
Provider Name (Legal Business Name): RASMUSSEN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 JUAN TABO BLVD NE SUITE 121-E
ALBUQUERQUE NM
87112-1886
US

IV. Provider business mailing address

PO BOX 21182
ALBUQUERQUE NM
87154-1182
US

V. Phone/Fax

Practice location:
  • Phone: 505-263-9375
  • Fax:
Mailing address:
  • Phone: 505-263-9375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2686
License Number StateNM

VIII. Authorized Official

Name: MR. MARTIN RASMUSSEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 505-263-9375