Healthcare Provider Details

I. General information

NPI: 1639504442
Provider Name (Legal Business Name): ROWEN O'NEILL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106-2653
US

IV. Provider business mailing address

601 LOVEJOY RD SW
ALBUQUERQUE NM
87105-3849
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-8866
  • Fax:
Mailing address:
  • Phone: 360-842-7632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0199011
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: