MEDICARE: DR. AMALIA HUMADA-LUDEKE LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	0190651	NM

General Provider Information

NPI Number	:	1447625678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMALIA HUMADA-LUDEKE LMFT

Provider Business Mailing Address
First Line	:	PO BOX 5040
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88062-5040
Country	:	US
Telephone Number	:	575-956-6135
Fax Number	:	575-956-6204

Provider Business Practice Location Address
First Line	:	530 HIGHWAY 180 W
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-4400
Country	:	US
Telephone Number	:	575-956-6135
Fax Number	:	575-956-6204

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	07/21/2022

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