Provider Demographics
NPI:1376603373
Name:HISCOX, MARIELA (LPCC LADAC)
Entity Type:Individual
Prefix:MS
First Name:MARIELA
Middle Name:
Last Name:HISCOX
Suffix:
Gender:F
Credentials:LPCC LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51957
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87181-1957
Mailing Address - Country:US
Mailing Address - Phone:505-262-9393
Mailing Address - Fax:505-262-9393
Practice Address - Street 1:4135 MONTGOMERY BLVD NE
Practice Address - Street 2:STE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-262-9393
Practice Address - Fax:505-262-9393
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3769101YA0400X
NM2518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ3615Medicaid
NM20104772OtherPRESBYTERIAN
NMNM101090OtherVALUE OPTIONS
NM1064501OtherCIGNA