Healthcare Provider Details

I. General information

NPI: 1043221724
Provider Name (Legal Business Name): CONSULTING PSYCHOLOGICAL SERVICES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E 21ST ST SUITE D
CLOVIS NM
88101-4443
US

IV. Provider business mailing address

921 E 21ST ST SUITE D
CLOVIS NM
88101-4443
US

V. Phone/Fax

Practice location:
  • Phone: 505-762-0212
  • Fax: 505-762-0660
Mailing address:
  • Phone: 505-762-0212
  • Fax: 505-762-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number443
License Number StateNM

VIII. Authorized Official

Name: DR. MARK C MCGAUGHEY
Title or Position: PRESIDENT
Credential: PHD
Phone: 505-762-0212