Healthcare Provider Details

I. General information

NPI: 1275938094
Provider Name (Legal Business Name): DAWN RACHELLE GOODHEART LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 MALL DR STE C
LAS CRUCES NM
88011-8193
US

IV. Provider business mailing address

205 W BOUTZ RD BLDG 1
LAS CRUCES NM
88005-3259
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-2330
  • Fax:
Mailing address:
  • Phone: 575-532-7000
  • Fax: 575-532-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0140831
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: