Provider Demographics
NPI:1619584182
Name:HALLMAN, MARYBETH (LMHC)
Entity type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:HALLMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 LUISA ST STE 10
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4176
Mailing Address - Country:US
Mailing Address - Phone:505-458-8188
Mailing Address - Fax:
Practice Address - Street 1:1219 LUISA ST STE 10
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4176
Practice Address - Country:US
Practice Address - Phone:505-458-8188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0210571101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health