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General NPI Number Information
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NPI Number | 1407123789
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Entity Type | Organization
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Legal Business Name | MARK OVRICK LISW LSSW
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 1096 MECHEM DR SUITE 202
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City | RUIDOSO
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State | NM
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Zip | 88345-7067
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Country | US
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Telephone | 575-808-8380
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Fax | 575-808-8380
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Provider Business Mailing Address
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Address Line | 1096 MECHEM DR SUITE 202
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City | RUIDOSO
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State | NM
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Zip | 88345-7067
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Country | US
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Telephone | 575-808-8380
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Fax | 575-808-8380
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Authorized Official
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Title or Position | LICENSED INDEPENDENT SOCIAL WORKER
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Name | MARK OVRICK
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Credential | LISW
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Telephone | 575-937-5643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-05300
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License Number State | NM
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