Provider Demographics
NPI:1114264249
Name:SHUTTLEWORTH, MAYRE MARGARET (PHD, MA, LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:MAYRE
Middle Name:MARGARET
Last Name:SHUTTLEWORTH
Suffix:
Gender:F
Credentials:PHD, MA, LMHC, NCC
Other - Prefix:
Other - First Name:MAYRE
Other - Middle Name:MARGARET
Other - Last Name:HOSKISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, MA, LMHC, NCC
Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3401
Mailing Address - Fax:505-272-6091
Practice Address - Street 1:1213 UNIVERSITY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1703
Practice Address - Country:US
Practice Address - Phone:505-272-3401
Practice Address - Fax:505-272-6091
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0153161101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor