Provider Demographics
NPI:1235553769
Name:ABERNATHY, MANDI (LMHC)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 TIJERAS AVENUE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3650
Mailing Address - Country:US
Mailing Address - Phone:505-243-2223
Mailing Address - Fax:
Practice Address - Street 1:803 TIJERAS AVENUE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3650
Practice Address - Country:US
Practice Address - Phone:505-243-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0163661101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13866614OtherCAQH