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1881207496
KEVIN RYAN PUCKETT
ALBUQUERQUE, NM
NPI
1881207496
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
103TA0400X Psychologist, Addiction (Substance Use Disorder)
(Licence: NM CSA0210841)
Enumeration Date
2020-08-25
Last Update Date
2020-08-25
Business Address
KEVIN RYAN PUCKETT LSAA
1528 FIVE POINTS RD SW
ALBUQUERQUE, NM 87105-3179
Phone number: 505-242-6919
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Mailing Address
KEVIN RYAN PUCKETT LSAA
1805 LLANO CT NW
ALBUQUERQUE, NM 87107-2631
Phone number: 505-506-7595
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