Organization
PICKENS MOORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PICKENS MOORE (LISW)
(505) 863-7472
Entity
Organization
Contact information
Practice address
100 E AZTEC AVE, GALLUP, NM 87301-6256
(505) 863-7472
(505) 863-7472
Mailing address
3306 CHURCH ROCK ST, GALLUP, NM 87301-4506
(505) 863-7472
(505) 863-7472
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
I-3118
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
L9282
—
NM
Enumeration date
04/15/2016
Last updated
04/15/2016
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