Basic Information
| Provider Information | |||||||||
| NPI: | 1316380884 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRUELOCK | ||||||||
| FirstName: | MARILYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 W 21ST ST | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 881014151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757692345 | ||||||||
| FaxNumber: | 5757698974 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 S MONROE ST | ||||||||
| Address2: | |||||||||
| City: | TUCUMCARI | ||||||||
| State: | NM | ||||||||
| PostalCode: | 884013208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5754613013 | ||||||||
| FaxNumber: | 5754611169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2013 | ||||||||
| LastUpdateDate: | 12/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/26/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.