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NPI Code Detail

MEDICARE: MARY BRADTKE LMHC

MEDICARE: MARY BRADTKE LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorCMH0211161NM

General Provider Information

NPI Number : 1760136444
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY BRADTKE LMHC
Provider Business Mailing Address
First Line : 7 MONTANA VIS
Second Line :
City : SANTA FE
State : NM
Zip : 87507-0148
Country : US
Telephone Number : 443-569-2905
Fax Number :
Provider Business Practice Location Address
First Line : 3952 SAN FELIPE RD
Second Line :
City : SANTA FE
State : NM
Zip : 87507-8073
Country : US
Telephone Number : 443-569-2905
Fax Number : 505-471-8575
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2022
Last Update Date : 02/10/2022

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Directions to “ MARY BRADTKE LMHC” Practice Location

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