Individual
MARY M ARCHIBEQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1409 ELK RIDGE RD NE, ALBUQUERQUE, NM 87113-0301
(505) 712-6451
Mailing address
1409 ELK RIDGE RD NE, ALBUQUERQUE, NM 87113-0301
(505) 712-6451
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0168661
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12625011
CAQH
NM
05
—
15606562
—
NM
Enumeration date
06/17/2009
Last updated
08/04/2015
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