Individual
MARY R MCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1331 GUSDORF RD, EL CENTRO FAMILLY HEALTH-TAOS CLINIC, TAOS, NM 87571-6282
(575) 758-3601
(575) 758-1058
Mailing address
PO BOX 158, EL CENTRO FAMILLY HEALTH, ESPANOLA, NM 87532-0158
(505) 753-7218
(505) 753-5815
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M-08004
NM
Other
Enumeration date
11/07/2012
Last updated
11/07/2012
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