Provider Demographics
NPI:1184639882
Name:MOOMCHI, BUICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:BUICK
Middle Name:
Last Name:MOOMCHI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36006
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87176-6006
Mailing Address - Country:US
Mailing Address - Phone:505-294-1344
Mailing Address - Fax:505-294-1344
Practice Address - Street 1:2901 JUAN TABO BLVD NE
Practice Address - Street 2:SUITE 114
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1886
Practice Address - Country:US
Practice Address - Phone:505-615-1344
Practice Address - Fax:505-294-1344
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0180-P (DM9999)103TC0700X, 103T00000X
NM2337261041C0700X
NM0685101YP2500X, 101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27393Medicaid
00JQ22OtherBLUE CROSS/BLUE SHIELD
IP297833OtherMEGELAN BEH. HEALTH
NM233726 (600 &6001)OtherCLINICAL SOCIAL WORKER
NM104433OtherOPTIONS PRESBYTERIAN
NMA114172OtherVALUE OPTIONS
NMD3803Medicaid
NMZ7393Medicaid