Provider Demographics
NPI:1114122363
Name:MANCE, NANCY ELLEN (LPCC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ELLEN
Last Name:MANCE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 VIRGINIA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4659
Mailing Address - Country:US
Mailing Address - Phone:505-263-1982
Mailing Address - Fax:505-275-0296
Practice Address - Street 1:9741 CANDELARIA RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1401
Practice Address - Country:US
Practice Address - Phone:505-266-7711
Practice Address - Fax:505-268-5046
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0110621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM37436228Medicaid