Individual
MAVIS SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
RT 9 HWY 371 SUITE 2, CROWNPOINT, NM 87313
(505) 786-2333
Mailing address
P.O. BOX 1501, GALLUP, NM 87305
(505) 870-1347
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CCMH02077711
NM
Other
Enumeration date
11/09/2023
Last updated
11/09/2023
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