Healthcare Provider Details

I. General information

NPI: 1417344045
Provider Name (Legal Business Name): MARY JO BAIRD LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY JO CHAVEZ LMHC

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 HERMOSA DR SE
ALBUQUERQUE NM
87108-4312
US

IV. Provider business mailing address

713 MARCELLA ST NE
ALBUQUERQUE NM
87123-1238
US

V. Phone/Fax

Practice location:
  • Phone: 505-237-0061
  • Fax: 505-237-0068
Mailing address:
  • Phone: 505-203-0789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0179271
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0173551
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: