Individual
TIMOTHY MIKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
707 BROADWAY BLVD NE STE 500, ALBUQUERQUE, NM 87102
(505) 268-0701
(505) 232-9055
Mailing address
707 BROADWAY BLVD NE STE 500, ALBUQUERQUE, NM 87102-2367
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M-09515
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18677037
—
NM
Enumeration date
03/13/2015
Last updated
09/06/2018
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