Individual
MR. WILLIS EDWIN BLACKMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
1337 GUSDORF ROAD, SUITES E & F, TAOS, NM 87571-6489
(575) 758-4297
(575) 751-7237
Mailing address
4787 NDCBU, TAOS, NM 87571-6032
(505) 737-0142
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
M-04831
NM
Other
Enumeration date
06/05/2007
Last updated
02/01/2012
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