| Mark Simpson Psyd Mac Ladc Llc | |
|
2920 Carlisle Blvd Ne Ste G Albuquerque NM 87110-2867 | |
| (505) 977-9180 | |
| (505) 792-7982 |
| Full Name | Mark Simpson Psyd Mac Ladc Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2920 Carlisle Blvd Ne Ste G, Albuquerque, New Mexico |
| Authorized Official Name and Position | Mark Stewart Simpson (OWNER) |
| Authorized Official Contact | 5059779180 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Simpson Psyd Mac Ladc Llc 2920 Carlisle Blvd Ne Ste G Albuquerque NM 87110-2867 Ph: (505) 977-9180 | Mark Simpson Psyd Mac Ladc Llc 2920 Carlisle Blvd Ne Ste G Albuquerque NM 87110-2867 Ph: (505) 977-9180 |
| NPI Number | 1124584313 |
|---|---|
| Provider Enumeration Date | 02/13/2019 |
| Last Update Date | 02/13/2019 |
| Medicare PECOS PAC ID | 8426465600 |
|---|---|
| Medicare Enrollment ID | O20210406001715 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124584313 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Mark S Simpson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518952662 PECOS PAC ID: 6709901044 Enrollment ID: I20100910000202 |
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