Healthcare Provider Details

I. General information

NPI: 1104500446
Provider Name (Legal Business Name): JULIE HUGHES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 GEORGIA ST NE STE A4
ALBUQUERQUE NM
87110-1391
US

IV. Provider business mailing address

3901 GEORGIA ST NE STE A4
ALBUQUERQUE NM
87110-1391
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-1583
  • Fax:
Mailing address:
  • Phone: 505-891-1583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberM-4077
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: