Healthcare Provider Details

I. General information

NPI: 1134456155
Provider Name (Legal Business Name): MARY E MCGINNIS MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST N10-D
SANTA FE NM
87505-2143
US

IV. Provider business mailing address

151 CALLE OJO FELIZ APT H
SANTA FE NM
87505-5788
US

V. Phone/Fax

Practice location:
  • Phone: 505-231-7431
  • Fax:
Mailing address:
  • Phone: 505-231-7431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2134
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: