Healthcare Provider Details

I. General information

NPI: 1518952662
Provider Name (Legal Business Name): MARK STEWART SIMPSON PSYD, LADAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 WYOMING BLVD NE STE 112
ALBUQUERQUE NM
87111-3288
US

IV. Provider business mailing address

4026 PLAZA COLINA NE
RIO RANCHO NM
87124-4785
US

V. Phone/Fax

Practice location:
  • Phone: 505-977-9180
  • Fax: 505-214-5897
Mailing address:
  • Phone: 505-977-9180
  • Fax: 505-214-5897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberPSY-RXP0067
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAD0081081
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0930
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: