Basic Information
Provider Information
NPI: 1467038695
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLS
FirstName: NORA
MiddleName: RAIN
NamePrefix:  
NameSuffix:  
Credential: LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 MENAUL BLVD NW
Address2: SUITE A #531
City: ALBUQUERQUE
State: NM
PostalCode: 871071347
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2221 RIO GRANDE BLVD NW
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871042529
CountryCode: US
TelephoneNumber: 5058301871
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/18/2021
LastUpdateDate: 03/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XT-CTL0215931NMY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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