Individual
MARY TRICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1421 SAN JOSE AVE SE, ALBUQUERQUE, NM 87106-5009
(404) 468-6941
Mailing address
1421 SAN JOSE AVE SE, ALBUQUERQUE, NM 87106-5009
(404) 468-6941
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
106S000000X
NM
Other
Enumeration date
11/01/2022
Last updated
11/01/2022
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