Healthcare Provider Details

I. General information

NPI: 1952851271
Provider Name (Legal Business Name): RATIONAL LIFESTYLE CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S LEA AVE
ROSWELL NM
88203-4562
US

IV. Provider business mailing address

310 S LEA AVE
ROSWELL NM
88203-4562
US

V. Phone/Fax

Practice location:
  • Phone: 505-269-4155
  • Fax:
Mailing address:
  • Phone: 505-269-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0132951
License Number StateNM

VIII. Authorized Official

Name: MS. RHONDA R GUTIERREZ
Title or Position: OWNER
Credential: LPCC
Phone: 505-269-4155