| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 10/26/2007 |
| Last Update Date | 02/10/2024 |
| Certification Date | 02/10/2024 |
| Medicare PECOS PAC ID | 7113819350 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124095096 PECOS PAC ID: 0648162883 Enrollment ID: I20040326000599 |
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