Healthcare Provider Details

I. General information

NPI: 1598218190
Provider Name (Legal Business Name): WALK THE WALK COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 09/02/2025
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 GOLF COURSE RD SE STE D
RIO RANCHO NM
87124-1634
US

IV. Provider business mailing address

2111 GOLF COURSE RD SE STE D
RIO RANCHO NM
87124-1634
US

V. Phone/Fax

Practice location:
  • Phone: 505-639-1312
  • Fax:
Mailing address:
  • Phone: 505-639-1312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI-06999
License Number StateNM

VIII. Authorized Official

Name: MRS. JENNIFER BETH ROSE
Title or Position: SOLE PROPRIETOR
Credential: LISW
Phone: 505-639-1312