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General NPI Number Information
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NPI Number | 1568746436
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Entity Type | Organization
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Legal Business Name | UNM DEPARTMENT OF PSYCHOLOGY CLINIC
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | MSC 02 1675 1820 SIGMA CHI NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87131-0001
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Country | US
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Telephone | 505-277-5164
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Fax | 505-277-7519
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Provider Business Mailing Address
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Address Line | MSC 02 1675 1820 SIGMA CHI NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87131-0001
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Country | US
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Telephone | 505-277-5164
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Fax | 505-277-7519
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DAN MATTHEWS
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Credential | PH.D.
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Telephone | 505-277-5164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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