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Individual

MR. JONATHAN TRIMBLE MACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
EDM, LPCC

Contact information

Practice address
7109 PROSPECT PL NE, ALBUQUERQUE, NM 87110-4313
(505) 796-4004
(505) 830-3264
Mailing address
PO BOX 1613, PERALTA, NM 87042-1613
(505) 796-4004
(505) 866-9278

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0086461
NM

Other

Enumeration date
05/08/2006
Last updated
03/08/2010
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