Healthcare Provider Details

I. General information

NPI: 1629435532
Provider Name (Legal Business Name): REBECCA PICKLE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 UPTOWN BLVD NE STE 140
ALBUQUERQUE NM
87110-4157
US

IV. Provider business mailing address

6800 VISTA DEL NORTE RD NE APT 821
ALBUQUERQUE NM
87113-1373
US

V. Phone/Fax

Practice location:
  • Phone: 505-259-3995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0198961
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: