Healthcare Provider Details

I. General information

NPI: 1124934021
Provider Name (Legal Business Name): DESERT SAGE COUNSELING & CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 DESERT SAGE AVE SW
LOS LUNAS NM
87031-5238
US

IV. Provider business mailing address

PO BOX 104
BELEN NM
87002-0104
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-1220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name: REBECCA KAY MIKKELSON
Title or Position: OWNER/MANAGING MEMBER
Credential: CRC, LPCC
Phone: 505-710-8973