Individual
REBECCA K MIKKELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1402 MAIN ST NW STE B, LOS LUNAS, NM 87031-6183
(505) 710-8973
Mailing address
2960 DESERT SAGE AVE SW, LOS LUNAS, NM 87031-5238
(505) 710-8973
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CTB-2025-0709
NM
101YP2500X
Professional Counselor
CTB-2025-0709
NM
101YS0200X
School Counselor
350377
NM
225C00000X
Rehabilitation Counselor
350377
NM
Other
Enumeration date
10/06/2025
Last updated
10/06/2025
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