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NPI Code Detail

MEDICARE: MR. RICK L CHURCH L.P.C.C.

MEDICARE:  MR. RICK L CHURCH  L.P.C.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor84321NM

General Provider Information

NPI Number : 1255376323
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICK L CHURCH L.P.C.C.
Provider Business Mailing Address
First Line : PO BOX 1242
Second Line :
City : ABIQUIU
State : NM
Zip : 87510-1242
Country : US
Telephone Number : 505-685-0547
Fax Number :
Provider Business Practice Location Address
First Line : 1505 15TH ST
Second Line :
City : LOS ALAMOS
State : NM
Zip : 87544-3000
Country : US
Telephone Number : 505-662-3264
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2006
Last Update Date : 07/08/2007

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Directions to “ MR. RICK L CHURCH L.P.C.C.” Practice Location

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