Healthcare Provider Details

I. General information

NPI: 1912976648
Provider Name (Legal Business Name): PSYCHOLOGY & COUNSELING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 TELLES ST SW
LOS LUNAS NM
87031-8518
US

IV. Provider business mailing address

PO BOX 1757 119 TELES SW
LOS LUNAS NM
87031-1757
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-7100
  • Fax: 505-865-7100
Mailing address:
  • Phone: 505-865-7100
  • Fax: 505-865-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number174
License Number StateNM

VIII. Authorized Official

Name: DR. CLIFFORD O. MORGAN JR.
Title or Position: PRESIDENT/OWNER
Credential: PH.D
Phone: 505-865-7100