Healthcare Provider Details

I. General information

NPI: 1891046777
Provider Name (Legal Business Name): REBECCA LOUISE SCOTT LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6312 MONTANO RD NW SUITE E
ALBUQUERQUE NM
87120-2170
US

IV. Provider business mailing address

7719 KENTWOOD AVE NW
ALBUQUERQUE NM
87114-4165
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-1155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0150851
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: