Individual
MR. MICJHAEL PATRICK O'MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADAC
Contact information
Practice address
715 E IDAHO AVE, 4B, LAS CRUCES, NM 88001-4703
(575) 524-2505
(575) 524-2504
Mailing address
PO BOX 373, RADIUM SPRINGS, NM 88054-0373
(575) 621-9660
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LADAC3619
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LADAC3619
LICENSE NUMBER
NM
Enumeration date
05/04/2010
Last updated
05/04/2010
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