Healthcare Provider Details

I. General information

NPI: 1548385396
Provider Name (Legal Business Name): AUDRA E MCCARTHY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 SAN MATEO BLVD NE STE S14
ALBUQUERQUE NM
87110-4081
US

IV. Provider business mailing address

5800 OSUNA RD NE APT 215
ALBUQUERQUE NM
87109-6255
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-1871
  • Fax:
Mailing address:
  • Phone: 505-350-1706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0101641
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: