| Pickens Moore | |
|
100 E Aztec Ave Gallup NM 87301-6256 | |
| (505) 863-7472 | |
| (505) 863-7472 |
| Full Name | Pickens Moore |
|---|---|
| Speciality | Social Worker |
| Location | 100 E Aztec Ave, Gallup, New Mexico |
| Authorized Official Name and Position | Pickens Moore (LISW) |
| Authorized Official Contact | 5058637472 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pickens Moore 3306 Church Rock St Gallup NM 87301-4506 Ph: (505) 863-7472 | Pickens Moore 100 E Aztec Ave Gallup NM 87301-6256 Ph: (505) 863-7472 |
| NPI Number | 1770937732 |
|---|---|
| Provider Enumeration Date | 04/15/2016 |
| Last Update Date | 04/15/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770937732 | NPI | - | NPPES |
| L9282 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | I-3118 (New Mexico) | Primary |
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