Provider Demographics
NPI:1134456155
Name:MCGINNIS, MARY E (MA, LPCC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CALLE OJO FELIZ APT H
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5788
Mailing Address - Country:US
Mailing Address - Phone:505-231-7431
Mailing Address - Fax:
Practice Address - Street 1:2019 GALISTEO ST
Practice Address - Street 2:N10-D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2143
Practice Address - Country:US
Practice Address - Phone:505-231-7431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional