Individual
MARY SUE BLACKHURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
110 E MESCALERO RD, ROSWELL, NM 88201-6542
(575) 755-2272
(575) 622-3325
Mailing address
110 E MESCALERO RD, ROSWELL, NM 88201
(575) 755-2272
(575) 622-3325
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0080161
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9057051
—
NM
Enumeration date
11/10/2005
Last updated
07/21/2022
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