Doctor Name: | EUGENE G AGNES |
NPI Number: | 1861424970 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD, LPCC |
License Number: | 1130 |
Business Practice Address: | 1701 Us Rt. 66 Suite D Moriarty, NM - 87035 |
Business Phone Number: | 5058329135 |
Business Fax Number: | 5058329404 |
Mailing Address: | Po Box 1978, MORIARTY |
State: | NM |
Postal Code: | 870351978 |
Phone Number: | 5058329135 |
Fax Number: | 5058329404 |
NPI Enumeration Date: | 07/07/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 1130 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |