Emily Fossum, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CCMH0224041 Issued in NM

Practice address

835 Spruce St Ste C&D
Espanola, NM 87532-3455

Phone

(505) 747-7400

Fax

(505) 747-7403

NPI assigned

Nov 30, 2016

Last updated

Apr 25, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Emily Maria Raffel Former name

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Presbyterian Medical Services

  dba Rio Rancho Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Rio Rancho, NM
  • NPI 1871505032
  Medicare reassignment NPD
• Earth and Sky Psychotherapy LLC

  • Adult Mental Health Clinic/Center
  • Santa Fe, NM
  • NPI 1629826250
  NPD Authorized official
• Presbyterian Medical Services

  dba PMS Central Pharmacy

  • Community/Retail Pharmacy
  • Albuquerque, NM
  • NPI 1306654462
  NPD
• Presbyterian Medical Services

  dba Carlsbad Family Health Center Behavioral Health

  • Clinic/Center
  • Carlsbad, NM
  • NPI 1629468830
  NPD
• Central Minnesota Mental Health Center

  • Counselor
  • Saint Cloud, MN
  • NPI 1053576546
  NPD (past)
• Central Minnesota Mental Health Center

  • Mental Health Counselor
  • Elk River, MN
  • NPI 1164934303
  NPD (past)

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

{
    "created_epoch": "1480464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1528501079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 SPRUCE ST STE C&D",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875323455",
            "telephone_number": "505-747-7400",
            "fax_number": "505-747-7403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 SPRUCE ST STE C&D",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875323455",
            "telephone_number": "505-747-7400",
            "fax_number": "505-747-7403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOSSUM",
        "first_name": "EMILY",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-30",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC01318",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NM",
            "license": "CCMH0224041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "RAFFEL",
            "middle_name": "MARIA",
            "credential": "L.P.C.C.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cassandra Y Fernandez, BMS
• Rickie Isaiah Fierro, LMHC
• Wendy Fisher
• Ronnie James Flores, CPSW
• Folsom Anesthesia LLC
• Margaret Fox, MD
• Jessyca Franco Chavez, ND
• Marisol Cecilia Franco, LMT
• Robert W Frasier III, MDPC
• Jessica Maureen Frechette-Gutfreund, LM, CPM

• Professional Counselor in Espanola, NM
• Providers in Espanola, NM by specialty
• Professional Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.