Healthcare Provider Details

I. General information

NPI: 1669991840
Provider Name (Legal Business Name): RENA MARIE HOSKINS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 UNSER BLVD NE
RIO RANCHO NM
87124-4045
US

IV. Provider business mailing address

500 4TH ST NW SUITE 102 PMB 2738
ALBUQUERQUE NM
87102-4045
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-0928
  • Fax: 505-896-0585
Mailing address:
  • Phone: 505-273-1612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1669991840
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0214621
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2023-0701
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: