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Individual

MARY M CLINE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA, LPCC

Contact information

Practice address
33 VISTA DE ORO, PLACITAS, NM 87043-9227
(505) 697-1717
Mailing address
PO BOX 93727, ALBUQUERQUE, NM 87199-3727
(505) 697-1717

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CCMH0196071
NM
101YP2500X
Professional Counselor
Primary
CCMH0196071
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
33238871
NM
Enumeration date
10/30/2015
Last updated
12/13/2020
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