Provider Demographics
NPI:1568601367
Name:CHRISTIE, MARY (LPCC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CHRISTIE
Other - Last Name:MURTAGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:1135 W MEADOWLARK LN
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-9689
Mailing Address - Country:US
Mailing Address - Phone:505-573-0392
Mailing Address - Fax:
Practice Address - Street 1:1135 W MEADOWLARK LN
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-9689
Practice Address - Country:US
Practice Address - Phone:505-573-0392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health