Individual
DR. JOE BOB AUTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
101 SECOND NORTH SECOND STREET, RATON, NM 87740
(505) 445-7090
Mailing address
105303 ROAD 66, KIM, CO 81049
(719) 643-5323
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
271964
NM
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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