Provider Demographics
NPI:1235553769
Name:ABERNATHY, MANDI (LPCC)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 COWBOY WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-9616
Mailing Address - Country:US
Mailing Address - Phone:505-508-7071
Mailing Address - Fax:
Practice Address - Street 1:215 COWBOY WAY STE 106
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-9616
Practice Address - Country:US
Practice Address - Phone:505-508-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0606101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13866614OtherCAQH