Individual
CLARENCE AUSTIN CHURCH III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
2901 E 20TH ST, FARMINGTON, NM 87402-4411
(505) 326-0241
Mailing address
74 ROAD 3900, FARMINGTON, NM 87401-3203
(719) 502-1366
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CTL0222201
NM
Other
Enumeration date
04/11/2022
Last updated
04/11/2022
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