Provider Demographics
NPI:1023354941
Name:VOSS, MARK R (LPCC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:VOSS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 VISTA OESTE NW, STE E #3102
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3373
Mailing Address - Country:US
Mailing Address - Phone:505-437-0125
Mailing Address - Fax:
Practice Address - Street 1:HOLZWEG 52
Practice Address - Street 2:
Practice Address - City:ELMSHORN
Practice Address - State:SCHLESWIG-HOLSTEIN
Practice Address - Zip Code:25337
Practice Address - Country:DE
Practice Address - Phone:505-437-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0175371101YP2500X
NM0156721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM98874373Medicaid