Provider Demographics
NPI:1063610491
Name:EUBANK, WILLIAM P (MS, MA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:P
Last Name:EUBANK
Suffix:
Gender:M
Credentials:MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97A ROAD 5295
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-1532
Mailing Address - Country:US
Mailing Address - Phone:505-327-0264
Mailing Address - Fax:505-325-9035
Practice Address - Street 1:2103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-3220
Practice Address - Country:US
Practice Address - Phone:505-327-0264
Practice Address - Fax:505-325-9035
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0095601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health