Healthcare Provider Details

I. General information

NPI: 1104365329
Provider Name (Legal Business Name): ROZANNE MARIE HURST LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 HIGHWAY 528 SUITE 205
RIO RANCHO NM
87124
US

IV. Provider business mailing address

4809 HAYDEN PL NW
ALBUQUERQUE NM
87120-3227
US

V. Phone/Fax

Practice location:
  • Phone: 505-814-1460
  • Fax:
Mailing address:
  • Phone: 505-350-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0190011
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: