Healthcare Provider Details

I. General information

NPI: 1053290890
Provider Name (Legal Business Name): RACHEL R RASCON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3549 MARTINEZ RD W
EDGEWOOD NM
87015-7082
US

IV. Provider business mailing address

3549 MARTINEZ RD W
EDGEWOOD NM
87015-7082
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-7870
  • Fax: 505-688-7870
Mailing address:
  • Phone: 505-688-7870
  • Fax: 505-688-7870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2024-0742
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: