Individual
MICHAEL OLLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
872 S CAMINO DEL PUEBLO, BERNALILLO, NM 87004-5927
(505) 867-2383
(505) 867-7293
Mailing address
55 EL CEDRO RD, TIJERAS, NM 87059-7429
(505) 565-1619
(505) 565-1620
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LISW - I-05823
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11282053
—
NM
Enumeration date
08/05/2006
Last updated
05/02/2008
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