Provider Demographics
NPI:1407123789
Name:MARK OVRICK LISW LSSW
Entity Type:Organization
Organization Name:MARK OVRICK LISW LSSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED INDEPENDENT SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:OVRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:575-937-5643
Mailing Address - Street 1:1096 MECHEM DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-7067
Mailing Address - Country:US
Mailing Address - Phone:575-808-8380
Mailing Address - Fax:575-808-8380
Practice Address - Street 1:1096 MECHEM DR
Practice Address - Street 2:SUITE 202
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7067
Practice Address - Country:US
Practice Address - Phone:575-808-8380
Practice Address - Fax:575-808-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-053001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty