Provider Demographics
NPI:1871730879
Name:OVRICK, MARK
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:OVRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 MECHEM DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-7213
Mailing Address - Country:US
Mailing Address - Phone:575-258-4946
Mailing Address - Fax:575-258-4949
Practice Address - Street 1:1204 MECHEM DR
Practice Address - Street 2:SUITE 11
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7213
Practice Address - Country:US
Practice Address - Phone:575-258-4946
Practice Address - Fax:575-258-4949
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2024-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-053001041C0700X
LA18730104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical