Healthcare Provider Details

I. General information

NPI: 1942327234
Provider Name (Legal Business Name): DUSTY LEE HUMES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 ALOYSIA LN NW
ALBUQUERQUE NM
87104-1723
US

IV. Provider business mailing address

2631 ALOYSIA LN NW
ALBUQUERQUE NM
87104-1723
US

V. Phone/Fax

Practice location:
  • Phone: 512-917-3126
  • Fax:
Mailing address:
  • Phone: 512-917-3126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4275
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number4275
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberNM1213
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: