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General NPI Number Information
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NPI Number | 1952461675
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Entity Type | Individual
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Provider Name | MICHAEL DOUGLAS MCGLATHERY LMFT
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Gender | Male
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 827 PASEO DEL PUEBLO NORTE
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City | TAOS
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State | NM
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Zip | 87571-6887
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Country | US
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Telephone | 575-770-9262
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Fax | 575-751-4205
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Provider Business Mailing Address
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Address Line | HC 74 BOX 21808
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City | EL PRADO
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State | NM
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Zip | 87529-9518
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Country | US
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Telephone | 575-770-9262
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Fax | 575-751-4205
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC15978
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0087631
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License Number State | NM
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