Provider Demographics
NPI:1598218190
Name:WALK THE WALK COUNSELING LLC
Entity type:Organization
Organization Name:WALK THE WALK COUNSELING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-639-1312
Mailing Address - Street 1:2111 GOLF COURSE RD SE STE D
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1634
Mailing Address - Country:US
Mailing Address - Phone:505-639-1312
Mailing Address - Fax:
Practice Address - Street 1:2111 GOLF COURSE RD SE STE D
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1634
Practice Address - Country:US
Practice Address - Phone:505-639-1312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-29
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-06999101YM0800X, 261QM0801X
NMC-06999251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02351714Medicaid
1598218190OtherNPI TYPE 2
NM17301866Medicaid
NM1104864255OtherNPI TYPE 1