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General NPI Number Information
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NPI Number | 1962773754
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Entity Type | Individual
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Provider Name | MARY EMALIE TIPTON LMHC
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Gender | Female
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 2055 S PACHECO ST
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City | SANTA FE
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State | NM
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Zip | 87505-3997
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Country | US
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Telephone | 505-702-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 17 AMORAK RD
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City | RANCHOS DE TAOS
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State | NM
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Zip | 87557-8720
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Country | US
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Telephone | 575-224-1112
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CTB-2023-0901
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License Number State | NM
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