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NPI Code Detail

MEDICARE: NEUROPSYCHOLOGICAL SERVICES OF NEW MEXICO, LLC

MEDICARE: NEUROPSYCHOLOGICAL SERVICES OF NEW MEXICO, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103G00000XClinical Neuropsychologist0969NM
2103TC0700XClinical Psychologist0969NM
3103TP0016XPrescribing (Medical) Psychologist

General Provider Information

NPI Number : 1326115049
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEUROPSYCHOLOGICAL SERVICES OF NEW MEXICO, LLC
Provider Business Mailing Address
First Line : 10110 SPAIN RD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87111-1965
Country : US
Telephone Number : 505-404-9395
Fax Number : 505-299-4740
Provider Business Practice Location Address
First Line : 10110 SPAIN RD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87111-1965
Country : US
Telephone Number : 505-404-9395
Fax Number : 505-299-4740
Authorized Official
Title or Position : DIRECTOR
Name : DR. JOHN HAROLD KING
Credential : PH.D.
Telephone Number : 505-404-9395
Provider Enumeration Date : 11/29/2006
Last Update Date : 05/27/2021

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