Provider Demographics
NPI:1578698593
Name:SCHUBERT, MARK ALLISON (PHD LMFT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLISON
Last Name:SCHUBERT
Suffix:
Gender:M
Credentials:PHD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 QUAIL RUN DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1141
Mailing Address - Country:US
Mailing Address - Phone:505-294-4724
Mailing Address - Fax:
Practice Address - Street 1:10409 MONTGOMERY PKWY WEST NE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-888-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2311106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist