Healthcare Provider Details

I. General information

NPI: 1295121192
Provider Name (Legal Business Name): RHONDA FREEMAN-MAZE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12216 HWY 14 N
CEDAR CREST NM
87008-9001
US

IV. Provider business mailing address

PO BOX 278
CEDAR CREST NM
87008-0278
US

V. Phone/Fax

Practice location:
  • Phone: 505-804-7297
  • Fax: 505-281-3002
Mailing address:
  • Phone: 505-804-7297
  • Fax: 505-281-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0154231
License Number StateNM

VIII. Authorized Official

Name: RHONDA SUE FREEMAN-MAZE
Title or Position: SOLE OWNER
Credential: LMHC
Phone: 505-804-7297