Provider Demographics
NPI:1518020338
Name:PARK, ROCHELLE RENEE (MA, LPC, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:RENEE
Last Name:PARK
Suffix:
Gender:F
Credentials:MA, LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 LOGGING TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-3625
Mailing Address - Country:US
Mailing Address - Phone:970-259-9284
Mailing Address - Fax:
Practice Address - Street 1:28000 ROAD T
Practice Address - Street 2:
Practice Address - City:DOLORES
Practice Address - State:CO
Practice Address - Zip Code:81323-9203
Practice Address - Country:US
Practice Address - Phone:970-882-1253
Practice Address - Fax:970-882-1500
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC4222101YM0800X
NM0116501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health