Healthcare Provider Details

I. General information

NPI: 1952815581
Provider Name (Legal Business Name): JOHN BALDY LMCH; SCHOOL PSYCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DOUGLAS AVE
LAS VEGAS NM
87701-3928
US

IV. Provider business mailing address

LAS VEGAS CITY SCHOOLS 901 DOUGLAS AVE.
LAS VEGAS NM
87701
US

V. Phone/Fax

Practice location:
  • Phone: 505-429-0022
  • Fax:
Mailing address:
  • Phone: 505-429-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number376037
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: