Organization
PMS WESTERN NM BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORRIE JEAN LAYCOCK (PSR AIDE)
(505) 863-3828
Entity
Organization
Contact information
Practice address
1 IDAHO CIR, GALLUP, NM 87301-5443
(505) 863-3828
Mailing address
2025 E AZTEC AVE, GALLUP, NM 87301-4803
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
09/26/2006
Last updated
08/14/2008
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