Healthcare Provider Details

I. General information

NPI: 1528099934
Provider Name (Legal Business Name): NELDA SUE DUFFEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NELDA SUE VESSELLS

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 MILES RD SE
ALBUQUERQUE NM
87106-3224
US

IV. Provider business mailing address

2418 MILES RD SE
ALBUQUERQUE NM
87106-3224
US

V. Phone/Fax

Practice location:
  • Phone: 505-767-9974
  • Fax: 505-842-1503
Mailing address:
  • Phone: 505-767-9974
  • Fax: 505-842-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0162
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: