| Clovis Counseling Center | |
|
921 E 21st St Suite D Clovis NM 88101-4443 | |
| (505) 762-0212 | |
| (505) 762-0660 |
| Full Name | Clovis Counseling Center |
|---|---|
| Speciality | Psychologist |
| Location | 921 E 21st St, Clovis, New Mexico |
| Authorized Official Name and Position | Mark C Mcgaughey (PRESIDENT) |
| Authorized Official Contact | 5057620212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clovis Counseling Center 921 E 21st St Suite D Clovis NM 88101-4443 Ph: (505) 762-0212 | Clovis Counseling Center 921 E 21st St Suite D Clovis NM 88101-4443 Ph: (505) 762-0212 |
| NPI Number | 1043221724 |
|---|---|
| Provider Enumeration Date | 08/10/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5597656538 |
|---|---|
| Medicare Enrollment ID | O20040322000317 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043221724 | NPI | - | NPPES |
| 47183 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 443 (New Mexico) | Primary |
| Provider Name | Eric M Banagay |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780883264 PECOS PAC ID: 5698838902 Enrollment ID: I20090113000629 |
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