Mark W Raybould, Lisw, Inc | |
2811 Indian School Rd Ne Albuquerque NM 87106-1825 | |
(505) 573-4044 | |
(505) 212-0975 |
Full Name | Mark W Raybould, Lisw, Inc |
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Speciality | Counselor |
Location | 2811 Indian School Rd Ne, Albuquerque, New Mexico |
Authorized Official Name and Position | Mark William Raybould (PRESIDENT/SOLE OWNER PROVIDER) |
Authorized Official Contact | 5055734044 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Mark W Raybould, Lisw, Inc 2811 Indian School Rd Ne Albuquerque NM 87106-1825 Ph: (505) 573-4044 | Mark W Raybould, Lisw, Inc 2811 Indian School Rd Ne Albuquerque NM 87106-1825 Ph: (505) 573-4044 |
NPI Number | 1770762775 |
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Provider Enumeration Date | 10/26/2007 |
Last Update Date | 02/10/2024 |
Certification Date | 02/10/2024 |
Medicare PECOS PAC ID | 7113819350 |
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Medicare Enrollment ID | O20040325000176 |
Identifier | Type | State | Issuer |
---|---|---|---|
1770762775 | NPI | - | NPPES |
NM01JC33 | Other | NM | BLUE CROSS |
81951876 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (New Mexico) | Primary |
Provider Name | Mark W Raybould |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1124095096 PECOS PAC ID: 0648162883 Enrollment ID: I20040326000599 |
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