Individual
MR. VERNON THOMAS JAQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
516 E. NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
(928) 697-4189
Mailing address
PO BOX 1337, GALLUP, NM 87305-1337
(505) 722-1000
(928) 697-4189
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-10278
NM
1041C0700X
Clinical Social Worker
M-04628
NM
Other
Enumeration date
11/15/2006
Last updated
06/10/2020
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