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Individual

LEWIS B TALK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSW LISW

Contact information

Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I0197
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
33927308
CO
05
697691
AZ
05
72182
NM
Enumeration date
11/02/2005
Last updated
05/20/2008
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