Healthcare Provider Details

I. General information

NPI: 1598695405
Provider Name (Legal Business Name): KIMBERLYNN BERNADETTE RAEL LSAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 GOLF COURSE RD SE STE A
RIO RANCHO NM
87124-5213
US

IV. Provider business mailing address

1912 VERBENA DR NE
RIO RANCHO NM
87144-6292
US

V. Phone/Fax

Practice location:
  • Phone: 505-359-0717
  • Fax:
Mailing address:
  • Phone: 505-359-0717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2026-0404
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: