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General NPI Number Information
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NPI Number | 1386283349
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Entity Type | Organization
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Legal Business Name | GOFF, LUNDY, & OLIVER, PSYCHOLOGICAL CONSULTANTS LLC
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Dates
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Enumeration Date | 12/22/2019
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Last Update Date | 12/22/2019
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Provider Practice Location Address
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Address Line | 3400 CONSTITUTION AVE NE STE C
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-1243
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Country | US
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Telephone | 505-373-3522
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Fax |
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Provider Business Mailing Address
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Address Line | 13409 DESERT HILLS PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3032
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Country | US
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Telephone | 505-373-3522
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Fax |
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Authorized Official
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Title or Position | PARTNER, CLINICAL NEUROPSYCHOLOGIST
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Name | DR. SHANNON LAURA LUNDY
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Credential | PHD
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Telephone | 505-373-3522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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