Healthcare Provider Details

I. General information

NPI: 1578184784
Provider Name (Legal Business Name): MARY ELIZABETH JOYCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date: 10/04/2024
Reactivation Date: 10/17/2024

III. Provider practice location address

508 COAL AVE SE
ALBUQUERQUE NM
87102-3913
US

IV. Provider business mailing address

712 NE 40TH ST
SEATTLE WA
98105-6415
US

V. Phone/Fax

Practice location:
  • Phone: 218-325-0517
  • Fax:
Mailing address:
  • Phone: 218-325-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: