Healthcare Provider Details

I. General information

NPI: 1902132319
Provider Name (Legal Business Name): MARY ALICE ARELLANO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 4TH AVE
RATON NM
87740-2643
US

IV. Provider business mailing address

PO BOX 314
SPRINGER NM
87747-0314
US

V. Phone/Fax

Practice location:
  • Phone: 575-445-2754
  • Fax: 575-445-2225
Mailing address:
  • Phone: 575-643-6834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0123541
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: