Healthcare Provider Details

I. General information

NPI: 1356830046
Provider Name (Legal Business Name): SEAN CLEARY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87110-4082
US

IV. Provider business mailing address

1660 OLD PECOS TRL STE A
SANTA FE NM
87505-4779
US

V. Phone/Fax

Practice location:
  • Phone: 505-548-9023
  • Fax: 505-531-8020
Mailing address:
  • Phone: 505-548-9023
  • Fax: 505-531-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT2CTL0195861
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2024-0847
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: