Healthcare Provider Details

I. General information

NPI: 1265609259
Provider Name (Legal Business Name): REBECCA EMMA SKEELE M.A. L.P.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 PLAZA BALENTINE
SANTA FE NM
87501-2739
US

IV. Provider business mailing address

339 PLAZA BALENTINE
SANTA FE NM
87501-2739
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-1739
  • Fax: 505-820-7009
Mailing address:
  • Phone: 505-984-1739
  • Fax: 505-820-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0095231
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: