Provider Demographics
NPI:1215347869
Name:NELSON, ROSE ANNA (LPCC)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:ANNA
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SAKELARES BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-3819
Mailing Address - Country:US
Mailing Address - Phone:505-876-1890
Mailing Address - Fax:505-876-1886
Practice Address - Street 1:1040 SAKELARES BLVD
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-3819
Practice Address - Country:US
Practice Address - Phone:505-876-1890
Practice Address - Fax:505-876-1886
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-CTL0206311101YM0800X
NMCCMH0225021101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health