Provider Demographics
NPI:1619526332
Name:MITCHELL, ROSALYN GALE
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:GALE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HAMILTON
Other - Middle Name:GALE
Other - Last Name:ROSALYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:THERAPIST
Mailing Address - Street 1:475 COURTHOUSE RD SE
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-9596
Mailing Address - Country:US
Mailing Address - Phone:505-565-9496
Mailing Address - Fax:
Practice Address - Street 1:475 COURTHOUSE RD SE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-9596
Practice Address - Country:US
Practice Address - Phone:505-565-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMT2223106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist