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General NPI Number Information
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NPI Number | 1659729960
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Entity Type | Organization
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Legal Business Name | CLINICAL COUNSELING, REBEKAH STEPHENS LLC
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 105 SOCORRO CIRCLE
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City | RUIDOSO
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State | NM
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Zip | 88345
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Country | US
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Telephone | 575-937-1288
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 733
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City | RUIDOSO
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State | NM
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Zip | 88355-0733
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL MENTAL HEALTH COUNSELOR,
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Name | MRS. REBEKAH STEPHENS
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Credential | LPCC, MS
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Telephone | 575-937-1288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0106671
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License Number State | NM
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