Healthcare Provider Details

I. General information

NPI: 1295561645
Provider Name (Legal Business Name): VICTORIA ANN COMPOCCIO STUDENT INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TORI ANN COMPOCCIO LMHC

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 RIO RANCHO BLVD NE STE 301
RIO RANCHO NM
87124-1456
US

IV. Provider business mailing address

PO BOX 45022
RIO RANCHO NM
87174-5022
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-0575
  • Fax: 505-461-6271
Mailing address:
  • Phone: 505-226-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB20250533
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: