Individual provider Active NPI

Mary Angelynn White, LPCC

  • Mental Health Counselor
  • Albuquerque, NM
National Provider Identifier
1902983182
Registry record updated Oct 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
CCMH0862 Issued in NM
Practice address
8600 Academy Rd NE
Albuquerque, NM 87111-1107
Phone
(505) 821-3628
NPI assigned
Nov 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X CCMH0862 NM Primary

Addresses

Primary practice location

8600 Academy Rd NE
Albuquerque, NM 87111-1107

Mailing address

8600 Academy Rd NE
Albuquerque, NM 87111-1107
Phone (505) 821-3628

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240129004544 NM Practitioner - Mental Health Counselor 6709239478 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Formation Counseling Services IncGroup PAC ID 9335387224, 15 clinicians

Practice addresses (Care Compare)

8600 Academy Rd NE
Albuquerque, NM 87111-1107
Phone (505) 821-3628

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CCMH0862NMMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Formation Counseling Services Inc CurrentSince Jan 1, 2024 Accepting new patients

Locations

8600 Academy Rd NE
Albuquerque, NM 87111

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538697600000",
    "number": "1902983182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 ACADEMY RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871111107",
            "telephone_number": "505-821-3628",
            "fax_number": "505-856-7103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 ACADEMY RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871111107",
            "telephone_number": "505-821-3628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "MARY",
        "middle_name": "ANGELYNN",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2018-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CCMH0862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.