Provider Demographics
NPI:1164115929
Name:MOUNT, EARL WOODWARD
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:WOODWARD
Last Name:MOUNT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 QUINCY ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1257
Mailing Address - Country:US
Mailing Address - Phone:505-550-1306
Mailing Address - Fax:
Practice Address - Street 1:146 QUINCY ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1257
Practice Address - Country:US
Practice Address - Phone:505-550-1306
Practice Address - Fax:844-434-8055
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)