Provider Demographics
NPI:1376304014
Name:MCCALL WELLNESS LLC
Entity Type:Organization
Organization Name:MCCALL WELLNESS LLC
Other - Org Name:MCCALL FAMILY WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-550-9366
Mailing Address - Street 1:6720 BOCA NEGRA PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1327
Mailing Address - Country:US
Mailing Address - Phone:505-550-9366
Mailing Address - Fax:
Practice Address - Street 1:6720 BOCA NEGRA PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1327
Practice Address - Country:US
Practice Address - Phone:505-550-9366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center