Healthcare Provider Details

I. General information

NPI: 1922061795
Provider Name (Legal Business Name): REBECCA ANN FROCK M.A., L.P.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 NEW HAMPTON NE
ALBUQUERQUE NM
87111-1891
US

IV. Provider business mailing address

8616 NEW HAMPTON RD NE
ALBUQUERQUE NM
87111-1891
US

V. Phone/Fax

Practice location:
  • Phone: 505-507-9087
  • Fax:
Mailing address:
  • Phone: 505-507-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH1314
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1314
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: