Healthcare Provider Details

I. General information

NPI: 1366255309
Provider Name (Legal Business Name): THE ROCK FAMILY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 GRANDE BLVD SE STE B5
RIO RANCHO NM
87124-1799
US

IV. Provider business mailing address

1380 RIO RANCHO BLVD SE # 403
RIO RANCHO NM
87124-1006
US

V. Phone/Fax

Practice location:
  • Phone: 505-336-0238
  • Fax: 505-317-1873
Mailing address:
  • Phone: 505-336-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROCKY MANUEL VILI
Title or Position: OWNER
Credential: LCSW
Phone: 505-336-0238