Doctor Name: | MR. RICK L CHURCH |
NPI Number: | 1255376323 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.P.C.C. |
License Number: | 84321 |
Business Practice Address: | 1505 15th St Los Alamos, NM - 875443000 |
Business Phone Number: | 5056623264 |
Business Fax Number: | |
Mailing Address: | Po Box 1242, ABIQUIU |
State: | NM |
Postal Code: | 875101242 |
Phone Number: | 5056850547 |
Fax Number: | |
NPI Enumeration Date: | 06/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 84321 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |