Pedersen Wellness and Rejuvenation

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

PEDERSEN WELLNESS AND REJUVENATION

Practice address

1740 Grande Blvd SE Ste E15
Rio Rancho, NM 87124-1799

Phone

(505) 507-1584

NPI assigned

Jun 12, 2023

Organization subpart

No

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

Authorized official

Name

Kelly Erika Pedersen, LMHCNPI 1174261515

Title

Owner

Phone

(806) 543-1429

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly Pedersen, LMHC

  • Mental Health Counselor
  • Rio Rancho, NM
  • NPI 1174261515
  NPD Authorized official

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

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687737600000",
    "number": "1831873744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9108 MANRESA DR NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871146471",
            "telephone_number": "806-543-1429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 GRANDE BLVD SE STE E15",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241799",
            "telephone_number": "505-507-1584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDERSEN WELLNESS AND REJUVENATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-12",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ERIKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "806-543-1429",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerri Payne
• Peak Medical New Mexico No. 3 LLC (Rio Rancho Center)
• Pearly Whites Dental Hygiene, Inc.
• Pearly Whites Dental Office, Inc.
• Allison Marie Pearson, MS, CCC-SLP
• Eric Pedersen, PA-C
• Kelly Pedersen, LMHC
• Pediatric Therapy Playground
• Pamela Pedraza, LMSW
• Ahmahn M Peeples, CPO/LPO, ACSM CPT

• Mental Health Counselor in Rio Rancho, NM
• Providers in Rio Rancho, NM by specialty
• Mental Health Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.