Healthcare Provider Details

I. General information

NPI: 1407308687
Provider Name (Legal Business Name): MAHALA SCOTT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 LAMBERTON PL NE
ALBUQUERQUE NM
87107-1641
US

IV. Provider business mailing address

1031 LAMBERTON PL NE
ALBUQUERQUE NM
87107-1641
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2190
  • Fax:
Mailing address:
  • Phone: 505-272-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0225691
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: