Healthcare Provider Details

I. General information

NPI: 1407610066
Provider Name (Legal Business Name): BROOKE LILLIANNA SCHULTZ LMHC LSAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 UNSER BLVD NE STE B
RIO RANCHO NM
87124-4045
US

IV. Provider business mailing address

184 UNSER BLVD NE STE B
RIO RANCHO NM
87124-4045
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-0928
  • Fax:
Mailing address:
  • Phone: 505-989-4500
  • Fax: 505-443-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2026-0293
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: