Healthcare Provider Details

I. General information

NPI: 1225136799
Provider Name (Legal Business Name): ROSWITHA HELENA HURST LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSE H HURST MA

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S AVENUE F
PORTALES NM
88130-5954
US

IV. Provider business mailing address

109 S AVENUE F
PORTALES NM
88130-5954
US

V. Phone/Fax

Practice location:
  • Phone: 575-714-1326
  • Fax:
Mailing address:
  • Phone: 575-714-1326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0091591
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number98187
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0091591
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number98187
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: