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Organization
FUTURA VISTA INC.
Active
Organization
FUTURA VISTA INC.
Active
Other names
Futura Vista Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM WALKER L.P.C.C. (CLINICAL DIRECTOR)
(505) 607-7774
Entity
Organization
Contact information
Practice address
1205 JONES ST, CLOVIS, NM 88101-5540
(505) 763-5887
(505) 762-9159
Mailing address
1205 JONES ST, CLOVIS, NM 88101-5540
(505) 763-5887
(505) 762-9159
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0672
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130187
—
NM
01
—
NM600911
VALUE OPTIONS PROVIDER ID
NM
Enumeration date
04/20/2007
Last updated
08/22/2020
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