=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598218190
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALK THE WALK COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2016
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2111 GOLF COURSE RD SE STE D
-----------------------------------------------------
City | RIO RANCHO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87124-1634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-639-1312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2111 GOLF COURSE RD SE STE D
-----------------------------------------------------
City | RIO RANCHO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87124-1634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-639-1312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | MRS. JENNIFER BETH ROSE
-----------------------------------------------------
Credential | LISW
-----------------------------------------------------
Telephone | 505-639-1312
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | I-06999
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------