MEDICARE: MS. RACHEL STIX NEILL 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	101YP2500X	Professional Counselor	CCMH0206191	NM

General Provider Information

NPI Number	:	1225172992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL STIX NEILL LPCC

Provider Business Mailing Address
First Line	:	835 SPRUCE ST STE CANDD
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-3455
Country	:	US
Telephone Number	:	505-747-7400
Fax Number	:	505-747-7403

Provider Business Practice Location Address
First Line	:	835 SPRUCE ST STE CANDD
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-3455
Country	:	US
Telephone Number	:	505-747-7400
Fax Number	:	505-747-7403

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	11/29/2021

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