Provider Demographics
NPI:1255376323
Name:CHURCH, RICK L (LPCC)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:L
Last Name:CHURCH
Suffix:
Gender:M
Credentials: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 1242
Mailing Address - Street 2:
Mailing Address - City:ABIQUIU
Mailing Address - State:NM
Mailing Address - Zip Code:87510-1242
Mailing Address - Country:US
Mailing Address - Phone:505-685-0547
Mailing Address - Fax:
Practice Address - Street 1:1505 15TH ST
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3000
Practice Address - Country:US
Practice Address - Phone:505-662-3264
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84321101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health