Mary M Cline, MA, LPCC – Professional Counselor

Key facts

NPI: 1255704185
Entity type: Individual (NPI type 1)
Primary specialty: Professional Counselor 101YP2500X
License: CCMH0196071 (NM)
Practice address: 33 Vista de Oro
Placitas, NM 87043-9227
Phone: (505) 697-1717
NPI assigned: Oct 30, 2015
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Mary M Cline, LLC Professional Counselor · Placitas, NM · NPI 1649704776

NPD Authorized official MENTAL HEALTH

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Master of Arts

State licenses

License	State	Type	Specialty
CCMH0196071	NM	MD	Mental Health Counselor

Practice roles

Organization	Specialty	Status	New patients
Mary M Cline, LLC	Mental Health	Current since Sep 27, 2020	Accepting new patients

Locations

3 Homesteads Rd
#F
Placitas, NM 87043
Phone (505) 401-7738

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Professional Counselor	101YP2500X	CCMH0196071	NM	Yes
Mental Health Counselor	101YM0800X	CCMH0196071	NM

Addresses

Primary practice location

33 Vista de Oro
Placitas, NM 87043-9227

Mailing address

PO Box 93727
Albuquerque, NM 87199-3727
Phone (505) 697-1717

Other identifiers

Identifier	Type	State	Issuer
33238871	Medicaid	NM

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 13, 2020.

{
    "created_epoch": "1446163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607817600000",
    "number": "1255704185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 93727",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871993727",
            "telephone_number": "505-697-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 VISTA DE ORO",
            "city": "PLACITAS",
            "state": "NM",
            "postal_code": "870439227",
            "telephone_number": "505-697-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLINE",
        "first_name": "MARY",
        "middle_name": "M",
        "credential": "MA, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-30",
        "last_updated": "2020-12-13",
        "certification_date": "2020-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NM",
            "license": "CCMH0196071",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CCMH0196071",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33238871",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Placitas, NM

All providers in Placitas, NM · Professional Counselor in New Mexico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.