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General NPI Number Information
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NPI Number | 1134598303
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Entity Type | Individual
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Provider Name | MINDY MCCLUNG MSW
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Gender | Female
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 2019 GALISTEO ST D2
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City | SANTA FE
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State | NM
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Zip | 87505-2143
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Country | US
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Telephone | 505-983-8225
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Fax |
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Provider Business Mailing Address
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Address Line | 20 BONITO RD
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City | SANTA FE
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State | NM
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Zip | 87508-8792
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Country | US
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Telephone | 505-231-8550
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | X-09299
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License Number State | NM
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