Healthcare Provider Details

I. General information

NPI: 1417852526
Provider Name (Legal Business Name): REBECCA FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 LOS CORDOVAS ROAD
RANCHOS DE TAOS NM
87557
US

IV. Provider business mailing address

PO BOX 1763
RANCHOS DE TAOS NM
87557-1763
US

V. Phone/Fax

Practice location:
  • Phone: 575-776-7625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCBT20240633
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: