Healthcare Provider Details

I. General information

NPI: 1063571412
Provider Name (Legal Business Name): MARY B MAULSBY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRANSITIONS TRANSITIONS

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 CONSTITUTION AVE NE
ALBUQUERQUE NM
87106-1238
US

IV. Provider business mailing address

PO BOX 582
SANDIA PARK NM
87047-0582
US

V. Phone/Fax

Practice location:
  • Phone: 505-281-9066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0088
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: