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Organization
MARK W RAYBOULD, LISW, INC
Active
Organization
MARK W RAYBOULD, LISW, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK WILLIAM RAYBOULD LCSW (PRESIDENT/SOLE OWNER PROVIDER)
(505) 573-4044
Entity
Organization
Contact information
Practice address
2811 INDIAN SCHOOL RD NE, ALBUQUERQUE, NM 87106-1825
(505) 573-4044
(505) 212-0975
Mailing address
2811 INDIAN SCHOOL RD NE, ALBUQUERQUE, NM 87106-1825
(505) 573-4044
(505) 212-0975
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81951876
—
NM
01
—
NM01JC33
BLUE CROSS
NM
Enumeration date
10/26/2007
Last updated
02/10/2024
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