Provider Demographics
NPI:1942242276
Name:MADRID, RACHEAL ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:ANNE
Last Name:MADRID
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FIRE STATION RD
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7188
Mailing Address - Country:US
Mailing Address - Phone:505-866-1034
Mailing Address - Fax:
Practice Address - Street 1:1010 LAS LOMAS RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2634
Practice Address - Country:US
Practice Address - Phone:505-246-8700
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0084601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health