| Professional Counseling Associates Of Nm | |
|
419 S 2nd St Tucumcari NM 88401-2859 | |
| (505) 461-3572 | |
| (505) 461-3572 |
| Full Name | Professional Counseling Associates Of Nm |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 419 S 2nd St, Tucumcari, New Mexico |
| Authorized Official Name and Position | Ralph Leonard Moya (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5054613572 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Counseling Associates Of Nm 419 S 2nd St Tucumcari NM 88401-2859 Ph: (505) 461-3572 | Professional Counseling Associates Of Nm 419 S 2nd St Tucumcari NM 88401-2859 Ph: (505) 461-3572 |
| NPI Number | 1962580175 |
|---|---|
| Provider Enumeration Date | 11/02/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962580175 | NPI | - | NPPES |
| I0930 | Other | NM | LISW |
| NMA3588 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LISW 1041CO700X (New Mexico) | Primary |
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