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General NPI Number Information
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NPI Number | 1770762775
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Entity Type | Organization
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Legal Business Name | MARK W RAYBOULD, LISW, INC
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 02/10/2024
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Provider Practice Location Address
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Address Line | 2811 INDIAN SCHOOL RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-1825
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Country | US
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Telephone | 505-573-4044
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Fax | 505-212-0975
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Provider Business Mailing Address
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Address Line | 2811 INDIAN SCHOOL RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-1825
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Country | US
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Telephone | 505-573-4044
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Fax | 505-212-0975
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Authorized Official
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Title or Position | PRESIDENT/SOLE OWNER PROVIDER
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Name | MARK WILLIAM RAYBOULD
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Credential | LCSW
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Telephone | 505-573-4044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | NM
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