Healthcare Provider Details

I. General information

NPI: 1841609401
Provider Name (Legal Business Name): BEYOND ENVISIONING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S TELSHOR BLVD UNIT R201
LAS CRUCES NM
88011-4688
US

IV. Provider business mailing address

755 S TELSHOR BLVD UNIT R201
LAS CRUCES NM
88011-4688
US

V. Phone/Fax

Practice location:
  • Phone: 575-571-1345
  • Fax:
Mailing address:
  • Phone: 575-571-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0141291
License Number StateNM

VIII. Authorized Official

Name: MS. REBECCA SNYDER ROSE
Title or Position: SOLE MEMBER
Credential: LPCC
Phone: 575-571-1345