Healthcare Provider Details

I. General information

NPI: 1881349256
Provider Name (Legal Business Name): LAURA GARCIA ROSECRANS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 LOS LENTES RD SE
LOS LUNAS NM
87031-7052
US

IV. Provider business mailing address

154 MITCHELL LOOP
BOSQUE FARMS NM
87068-9507
US

V. Phone/Fax

Practice location:
  • Phone: 505-944-6626
  • Fax:
Mailing address:
  • Phone: 505-730-3818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: