Individual
KELLY MARIE SHANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
8416 SONOMA VALLEY RD NE, ALBUQUERQUE, NM 87122-2626
(505) 459-4647
Mailing address
8416 SONOMA VALLEY RD NE, ALBUQUERQUE, NM 87122
(505) 459-4647
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0162101
NM
Other
Enumeration date
07/28/2008
Last updated
09/02/2016
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