Provider Demographics
NPI:1922097872
Name:RAYNE-LEVI, ANNA (LPCC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RAYNE-LEVI
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:EDELBROCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC
Mailing Address - Street 1:1691 GALISTEO ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4780
Mailing Address - Country:US
Mailing Address - Phone:505-954-1921
Mailing Address - Fax:505-983-6520
Practice Address - Street 1:1691 GALISTEO ST
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4780
Practice Address - Country:US
Practice Address - Phone:505-954-1921
Practice Address - Fax:505-983-6520
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM51730324Medicaid