Healthcare Provider Details

I. General information

NPI: 1134535032
Provider Name (Legal Business Name): ROSSI CATANA TERRY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 N PRINCE STREET SUITE B
CLOVIS NM
88101
US

IV. Provider business mailing address

044 SOUTH ROOSEVELT RD AD
PORTALES NM
88130
US

V. Phone/Fax

Practice location:
  • Phone: 575-760-0754
  • Fax:
Mailing address:
  • Phone: 575-760-0754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0090271
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: