Healthcare Provider Details

I. General information

NPI: 1457769895
Provider Name (Legal Business Name): VICKIE JO MCGINLEY D.B.H., L.P.C.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 08/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 YALE BLVD SE
ALBUQUERQUE NM
87106-4217
US

IV. Provider business mailing address

2600 YALE BLVD SE
ALBUQUERQUE NM
87106-4217
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-7999
  • Fax:
Mailing address:
  • Phone: 505-994-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0110251
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: