Healthcare Provider Details

I. General information

NPI: 1396964771
Provider Name (Legal Business Name): JAMES MADER LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6236 APACHE PLUME RD NE
RIO RANCHO NM
87144-5166
US

IV. Provider business mailing address

6236 APACHE PLUME RD NE
RIO RANCHO NM
87144-5166
US

V. Phone/Fax

Practice location:
  • Phone: 505-220-7782
  • Fax:
Mailing address:
  • Phone: 505-220-7782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2819
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: