Basic Information
| Provider Information | |||||||||
| NPI: | 1700451101 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIMAL | ||||||||
| FirstName: | KASSIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 907 | ||||||||
| Address2: | |||||||||
| City: | HOBBS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882410907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753933168 | ||||||||
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| Practice Location | |||||||||
| Address1: | 920 W BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | HOBBS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882405529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753933168 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2021 | ||||||||
| LastUpdateDate: | 10/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CTL0223971 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 42770700 | 05 | NM | MEDICAID |