Provider Demographics
NPI:1306995246
Name:MUNRO, MARK (LPCC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MUNRO
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W BROADWAY ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-6065
Mailing Address - Country:US
Mailing Address - Phone:505-393-0692
Mailing Address - Fax:505-393-0796
Practice Address - Street 1:215 W BROADWAY ST
Practice Address - Street 2:SUITE #1
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-6065
Practice Address - Country:US
Practice Address - Phone:505-393-0692
Practice Address - Fax:505-393-0796
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM0080591101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health