Healthcare Provider Details

I. General information

NPI: 1790239986
Provider Name (Legal Business Name): NAMASTE FAMILY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 GRANDE BLVD SE STE. C
RIO RANCHO NM
87124-1653
US

IV. Provider business mailing address

PO BOX 290
CORRALES NM
87048-0290
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-4959
  • Fax:
Mailing address:
  • Phone: 505-994-4959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA ELISABETH COLLA
Title or Position: MANAGER
Credential: LPCC
Phone: 505-994-4959