Healthcare Provider Details

I. General information

NPI: 1114396058
Provider Name (Legal Business Name): RENE TRICOU LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 PASEO PONDEROSA
SANTA FE NM
87501-6319
US

IV. Provider business mailing address

2100 PASEO PONDEROSA
SANTA FE NM
87501-6319
US

V. Phone/Fax

Practice location:
  • Phone: 541-357-9337
  • Fax:
Mailing address:
  • Phone: 541-306-8728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2024-0286
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCTB-2024-0286
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: