Individual provider Active NPI

Evelyn Marie Rainey, LPCC

  • Professional Counselor
  • Albuquerque, NM
National Provider Identifier
1134634215
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
CCMH0221451 Issued in NM
Practice address
5916 Anaheim Ave NE Ste a
Albuquerque, NM 87113
Phone
(505) 291-6314
Fax
(505) 275-0296
NPI assigned
Dec 11, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X T-0193431 NM
Professional Counselor 101YP2500X CCMH0221451 NM Primary

Addresses

Primary practice location

5916 Anaheim Ave NE Ste a
Albuquerque, NM 87113

Mailing address

5916 Anaheim Ave NE Ste a
Albuquerque, NM 87113-1894
Phone (505) 291-6314

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240131000142 NM Practitioner - Mental Health Counselor 9032569579 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Age to Age Counseling, PCGroup PAC ID 6305933151, 7 clinicians

Practice addresses (Care Compare)

5916 Anaheim Ave NE
Suite a
Albuquerque, NM 87113-1894
Phone (505) 291-6314

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
T-0193431NMMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Age to Age Counseling PC Mental Health CurrentSince Jan 1, 2024 Accepting new patients
Chrysalis Healthcare LLC Multi-Specialty PastSince Jun 1, 2023 Accepting new patients

Locations

5916 Anaheim Ave NE
Ste A
Albuquerque, NM 87113
Phone (505) 291-6314

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1134634215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5916 ANAHEIM AVE NE STE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871131894",
            "telephone_number": "505-291-6314",
            "fax_number": "505-275-0296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5916 ANAHEIM AVE NE STE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87113",
            "telephone_number": "505-291-6314",
            "fax_number": "505-275-0296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAINEY",
        "first_name": "EVELYN",
        "middle_name": "MARIE",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-11",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "T-0193431",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NM",
            "license": "CCMH0221451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.