Provider Demographics
NPI:1821324336
Name:RASMUSSEN, MARTIN A (LPCC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:A
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 INDIAN SCHOOL RD NE STE 234
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3180
Mailing Address - Country:US
Mailing Address - Phone:505-888-1362
Mailing Address - Fax:505-888-1376
Practice Address - Street 1:6121 INDIAN SCHOOL RD NE STE 234
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3180
Practice Address - Country:US
Practice Address - Phone:505-888-1362
Practice Address - Fax:505-888-1376
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2686101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health