Active NPI
Mavis Smith
- Mental Health Counselor
- Crownpoint, NM
National Provider Identifier
1649044710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- CCMH02077711
- Practice address
- RT 9 Hwy 371 Suite 2
Crownpoint, NM 87313 - Phone
- (505) 786-2333
- NPI assigned
- Nov 9, 2023
- Last updated
- Nov 9, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 | CCMH02077711 | NM | Primary |
Addresses
Primary practice location
RT 9 Hwy 371 Suite 2
Crownpoint, NM 87313
Mailing address
P.O. Box 1501
Gallup, NM 87305
Phone (505) 870-1347
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 |
|---|---|---|---|
| CCMH02077711 | NM | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1699488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699488000000",
"number": "1649044710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 1501",
"city": "GALLUP",
"state": "NM",
"postal_code": "87305",
"telephone_number": "505-870-1347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "RT 9 HWY 371 SUITE 2",
"city": "CROWNPOINT",
"state": "NM",
"postal_code": "87313",
"telephone_number": "505-786-2333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "MAVIS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-11-09",
"last_updated": "2023-11-09",
"certification_date": "2023-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NM",
"license": "CCMH02077711",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crownpoint, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.