Active NPI
Jonathan Trimble Mack, EDM, LPCC
- Mental Health Counselor
- Albuquerque, NM
National Provider Identifier
1295784353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 0086461
- Practice address
- 7109 Prospect PL NE
Albuquerque, NM 87110-4313 - Phone
- (505) 796-4004
- Fax
- (505) 830-3264
- NPI assigned
- May 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 0086461 | NM | Primary |
Addresses
Primary practice location
7109 Prospect PL NE
Albuquerque, NM 87110-4313
Mailing address
PO Box 1613
Peralta, NM 87042-1613
Phone (505) 796-4004
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0086461 | NM | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268006400000",
"number": "1295784353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1613",
"city": "PERALTA",
"state": "NM",
"postal_code": "870421613",
"telephone_number": "505-796-4004",
"fax_number": "505-866-9278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7109 PROSPECT PL NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871104313",
"telephone_number": "505-796-4004",
"fax_number": "505-830-3264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "JONATHAN",
"middle_name": "TRIMBLE",
"name_prefix": "Mr.",
"credential": "EDM, LPCC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-08",
"last_updated": "2010-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NM",
"license": "0086461",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.