Provider Demographics
NPI:1598759912
Name:MOYA, RALPH L (LISW/LPCC)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:L
Last Name:MOYA
Suffix:
Gender:M
Credentials:LISW/LPCC
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 392
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-0392
Mailing Address - Country:US
Mailing Address - Phone:505-306-6064
Mailing Address - Fax:
Practice Address - Street 1:419 S. 2ND STREET
Practice Address - Street 2:P.O. BOX 392
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-0392
Practice Address - Country:US
Practice Address - Phone:505-306-6064
Practice Address - Fax:505-306-6064
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2596101YM0800X
NMI-09301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM95411Medicaid