Basic Information
Provider Information
NPI: 1003146234
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBERTS
FirstName: RACHEL
MiddleName: OFFINEER
NamePrefix: MRS.
NameSuffix:  
Credential: LPCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: OFFINEER
OtherFirstName: RACHEL
OtherMiddleName: C.
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 10511 GOLF COURSE RD NW
Address2: SUITE 102
City: ALBUQUERQUE
State: NM
PostalCode: 87114
CountryCode: US
TelephoneNumber: 5057171155
FaxNumber: 5057171473
Practice Location
Address1: 10511 GOLF COURSE RD NW
Address2: SUITE 102
City: ALBUQUERQUE
State: NM
PostalCode: 87114
CountryCode: US
TelephoneNumber: 5057171155
FaxNumber: 5057171473
Other Information
ProviderEnumerationDate: 01/11/2010
LastUpdateDate: 11/05/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XT-0143151NMN Behavioral Health & Social Service ProvidersCounselorMental Health
101YP2500X  Y Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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