MEDICARE: RACHEAL ANNE MADRID LPC

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	0084601	NM

General Provider Information

NPI Number	:	1942242276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEAL ANNE MADRID LPC

Provider Business Mailing Address
First Line	:	100 FIRE STATION RD
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-7188
Country	:	US
Telephone Number	:	505-866-1034
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 LAS LOMAS RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-2634
Country	:	US
Telephone Number	:	505-246-8700
Fax Number	:

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/08/2007

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