Organization
NOVA III BEHAVIORAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID CONEJO (CEO)
(903) 820-1142
Entity
Organization
Contact information
Practice address
2418 E HIGHWAY 66, GALLUP, NM 87301-4767
(505) 297-3967
Mailing address
2418 E HIGHWAY 66, GALLUP, NM 87301-4767
(505) 297-3967
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
12/21/2021
Last updated
12/27/2021
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