Individual
KEITH MCCLISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
618 MANZANO ST NE, ALBUQUERQUE, NM 87110-6302
(505) 925-4044
Mailing address
10712 MCMICHAEL LN SW, ALBUQUERQUE, NM 87121-3643
(505) 925-4044
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
Other
Enumeration date
06/15/2010
Last updated
05/21/2014
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