Healthcare Provider Details

I. General information

NPI: 1588591622
Provider Name (Legal Business Name): DESERT SANDS MENTAL HEALTH AND PLAY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S AVENUE A STE B6
PORTALES NM
88130-5917
US

IV. Provider business mailing address

130 CREST POINTE DR
PORTALES NM
88130-9057
US

V. Phone/Fax

Practice location:
  • Phone: 575-607-5588
  • Fax:
Mailing address:
  • Phone: 575-607-5588
  • 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: REBBECCA JO GOSSETT
Title or Position: OWNER
Credential:
Phone: 575-607-5588