Individual
STACEY MCMULLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
1501 CERRILLOS RD, SANTA FE, NM 87505-3521
(505) 216-7325
(505) 395-7406
Mailing address
PO BOX 23625, SANTA FE, NM 87502-3625
(505) 660-8559
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
X-10748
NM
Other
Enumeration date
09/20/2018
Last updated
09/20/2018
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