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Organization
CHILD PSYCHOLOGY CENTER
Active
Organization
CHILD PSYCHOLOGY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRISCILLA ROTH-WALL PH.D. (PSYCHOLOGIST/OWNER)
(662) 603-1035
Entity
Organization
Contact information
Practice address
3751 N BUTLER AVE STE 115, FARMINGTON, NM 87401-6425
(662) 603-1035
Mailing address
3751 N BUTLER AVE STE 115, FARMINGTON, NM 87401-6425
(662) 603-1035
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Enumeration date
11/12/2019
Last updated
11/12/2019
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