Healthcare Provider Details

I. General information

NPI: 1942242276
Provider Name (Legal Business Name): RACHEAL ANNE MADRID LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LAS LOMAS RD NE
ALBUQUERQUE NM
87102-2634
US

IV. Provider business mailing address

100 FIRE STATION RD
LOS LUNAS NM
87031-7188
US

V. Phone/Fax

Practice location:
  • Phone: 505-246-8700
  • Fax:
Mailing address:
  • Phone: 505-866-1034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0084601
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: