Provider Demographics
NPI:1619068129
Name:MOURANT, PATRICIA A (LISW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:MOURANT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 FIELD DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2833
Mailing Address - Country:US
Mailing Address - Phone:505-328-0651
Mailing Address - Fax:
Practice Address - Street 1:6501 WYOMING BLVD NE
Practice Address - Street 2:BLDG. C, SUITE 105
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3932
Practice Address - Country:US
Practice Address - Phone:505-821-9700
Practice Address - Fax:505-821-9646
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-36141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical