Healthcare Provider Details

I. General information

NPI: 1699320895
Provider Name (Legal Business Name): KIMBERLY MEJIA RIOS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S TELSHOR BLVD STE 102
LAS CRUCES NM
88011-4688
US

IV. Provider business mailing address

4708 RUBICON RD
LAS CRUCES NM
88012-0852
US

V. Phone/Fax

Practice location:
  • Phone: 575-888-4666
  • Fax:
Mailing address:
  • Phone: 575-694-0122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCTB-2022-0091
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: