Healthcare Provider Details

I. General information

NPI: 1710291208
Provider Name (Legal Business Name): JUDY MCNEILSMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 STATE AVE
ALAMOSA CO
81101-3141
US

IV. Provider business mailing address

911 STATE AVE
ALAMOSA CO
81101-3141
US

V. Phone/Fax

Practice location:
  • Phone: 719-587-0538
  • Fax: 719-587-0388
Mailing address:
  • Phone: 719-587-0538
  • Fax: 719-587-0388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: