Healthcare Provider Details

I. General information

NPI: 1760505366
Provider Name (Legal Business Name): MARY WHEELER LAMPKIN LMHC #0126041
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 BECKER AVE
BELEN NM
87002-3631
US

IV. Provider business mailing address

513 BECKER AVE
BELEN NM
87002-3631
US

V. Phone/Fax

Practice location:
  • Phone: 505-864-3202
  • Fax:
Mailing address:
  • Phone: 505-864-3202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0126041
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: