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1215347869

NPI Code Detail

MEDICARE: ROSE ANNA NELSON LPCC

MEDICARE: ROSE ANNA NELSON LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	T-CTL0206311	NM
2	101YP2500X	Professional Counselor	CCMH0225021	NM

General Provider Information

NPI Number	:	1215347869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE ANNA NELSON LPCC

Provider Business Mailing Address
First Line	:	1040 SAKELARES BLVD
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-3819
Country	:	US
Telephone Number	:	505-876-1890
Fax Number	:	505-876-1886

Provider Business Practice Location Address
First Line	:	1040 SAKELARES BLVD
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-3819
Country	:	US
Telephone Number	:	505-876-1890
Fax Number	:	505-876-1886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	06/03/2022

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Directions to “ ROSE ANNA NELSON LPCC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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