Organization
FUTURA VISTA INC.
Active
Other names
Futura Vista Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM WALKER L.P.C.C. (CLINICAL DIRECTOR)
(505) 607-7774
Entity
Organization
Contact information
Practice address
1205 JONES ST, CLOVIS, NM 88101-5540
(505) 763-5887
(505) 762-9159
Mailing address
1205 JONES ST, CLOVIS, NM 88101-5540
(505) 763-5887
(505) 762-9159
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0672
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130187
—
NM
01
—
NM600911
VALUE OPTIONS PROVIDER ID
NM
Enumeration date
04/20/2007
Last updated
08/22/2020
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