Individual
BEVERLY LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 E HIGH ST, TUCUMCARI, NM 88401-2510
(575) 461-4411
(575) 461-4102
Mailing address
10228 STATE HIGHWAY 104, TUCUMCARI, NM 88401-9315
(575) 461-3868
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/27/2010
Last updated
07/27/2010
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