Provider Demographics
NPI:1780005025
Name:ROZELL, DONALD (LSAA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:ROZELL
Suffix:
Gender:M
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11005 SPAIN RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1899
Mailing Address - Country:US
Mailing Address - Phone:505-843-8450
Mailing Address - Fax:505-843-8449
Practice Address - Street 1:8100 MOUNTAIN RD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7818
Practice Address - Country:US
Practice Address - Phone:505-843-8450
Practice Address - Fax:505-843-8449
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0146961101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)