Healthcare Provider Details

I. General information

NPI: 1821479692
Provider Name (Legal Business Name): KASSANDRA WILLIAMS LAMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 CABEZON BLVD SE
RIO RANCHO NM
87124-1576
US

IV. Provider business mailing address

2441 CABEZON BLVD SE
RIO RANCHO NM
87124-1576
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-1155
  • Fax:
Mailing address:
  • Phone: 505-717-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0174611
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCMF0195051
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: