Healthcare Provider Details

I. General information

NPI: 1609671304
Provider Name (Legal Business Name): AMANDA LYNN ROSECRANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 SPAIN RD NE STE 106
ALBUQUERQUE NM
87109-3155
US

IV. Provider business mailing address

8205 SPAIN RD NE STE 106
ALBUQUERQUE NM
87109-3155
US

V. Phone/Fax

Practice location:
  • Phone: 505-856-0300
  • Fax: 505-856-7946
Mailing address:
  • Phone: 505-856-0300
  • Fax: 505-856-7946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: