Organization
NORTHERN NEW MEXICO NEUROPSYCHOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN PARKS PHD (DIRECTOR)
(505) 490-9049
Entity
Organization
Contact information
Practice address
1911 5TH ST STE 211, SANTA FE, NM 87505-5403
(505) 490-9049
Mailing address
1911 5TH ST STE 211, SANTA FE, NM 87505-5403
(505) 490-9049
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
1183
NM
103TC0700X
Clinical Psychologist
1183
NM
Other
Enumeration date
04/03/2012
Last updated
08/11/2016
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