Provider Demographics
NPI:1417344045
Name:BAIRD, MARY JO (LMHC)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:BAIRD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARY JO
Other - Middle Name:
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:713 MARCELLA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-1238
Mailing Address - Country:US
Mailing Address - Phone:505-203-0789
Mailing Address - Fax:
Practice Address - Street 1:1025 HERMOSA DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4312
Practice Address - Country:US
Practice Address - Phone:505-237-0061
Practice Address - Fax:505-237-0068
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0179271101YM0800X
NM0173551101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM21656568Medicaid