Individual
WAYNE KEITH HEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
1600 SUTTER PL, CLOVIS, NM 88101-4611
(505) 769-4490
(505) 935-0011
Mailing address
1609 BELVOIR CIR, CLOVIS, NM 88101-3983
(505) 762-0787
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
M1898
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000L3825
—
NM
Enumeration date
11/07/2006
Last updated
07/08/2007
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