Mary E Benally, LADAC, LISAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Shiprock, NM
NPI 1801003660 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1801003660
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 3814 (NM)
- Practice address
- Hwy 491 N., Pinon St.
Shiprock, NM 87420 - Phone
- (505) 368-1050
- Fax
- (505) 368-1055
- NPI assigned
- May 17, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3814 | NM | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 3814 | NM | Yes |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 11490 | AZ |
Addresses
Primary practice location
Hwy 491 N., Pinon St.
Shiprock, NM 87420
Mailing address
PO Box 102
Waterflow, NM 87421-0102
Phone (505) 368-1050
Other providers in Shiprock, NM
- Winifred Belinda Begodi
- Sandra Beirne
- Cherilynn Lea Benally
- Ethelinda W Benally
- Lucrecia Benally
- Nora J. Benally
- Norma J. Benally
- Johnny W Benson
- Anna Bergkamp
- Teresa Devereaux Bertone
All providers in Shiprock, NM · Addiction (Substance Use Disorder) 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 Jul 8, 2007. 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.