Healthcare Provider Details

I. General information

NPI: 1912224536
Provider Name (Legal Business Name): RITA T FRANKEN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 80 BOX 278
LAS VEGAS NM
87701-9596
US

IV. Provider business mailing address

HC 80 BOX 278
LAS VEGAS NM
87701-9596
US

V. Phone/Fax

Practice location:
  • Phone: 505-274-1920
  • Fax:
Mailing address:
  • Phone: 505-274-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI-06157
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: