Provider Demographics
NPI:1063571412
Name:MAULSBY, MARY B (LPCC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:MAULSBY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:TRANSITIONS
Other - Middle Name:
Other - Last Name:TRANSITIONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 582
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-0582
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3420 CONSTITUTION AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1238
Practice Address - Country:US
Practice Address - Phone:505-281-9066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0088101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health