Healthcare Provider Details

I. General information

NPI: 1942595723
Provider Name (Legal Business Name): MARY JAMES VAUX MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 NM HIGHWAY 105
ROCIADA NM
87742-0847
US

IV. Provider business mailing address

PO BOX 847
ROCIADA NM
87742-0847
US

V. Phone/Fax

Practice location:
  • Phone: 505-603-2004
  • Fax:
Mailing address:
  • Phone: 505-603-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0140191
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: