Provider Demographics
NPI:1225136799
Name:HURST, ROSWITHA HELENA (LPCC)
Entity Type:Individual
Prefix:MS
First Name:ROSWITHA
Middle Name:HELENA
Last Name:HURST
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MS
Other - First Name:ROSE
Other - Middle Name:H
Other - Last Name:HURST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:109 S AVENUE F
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-5954
Mailing Address - Country:US
Mailing Address - Phone:575-714-1326
Mailing Address - Fax:575-226-3495
Practice Address - Street 1:316 S ABILENE AVE
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6208
Practice Address - Country:US
Practice Address - Phone:575-226-3494
Practice Address - Fax:575-226-3495
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0091591101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health