Healthcare Provider Details

I. General information

NPI: 1043921869
Provider Name (Legal Business Name): NURSTEAD CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 COMMERCE WAY
CLOVIS NM
88101-4750
US

IV. Provider business mailing address

321 COMMERCE WAY
CLOVIS NM
88101-4750
US

V. Phone/Fax

Practice location:
  • Phone: 575-935-6262
  • Fax:
Mailing address:
  • Phone: 575-935-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN DEAN NUTT
Title or Position: OWNER
Credential:
Phone: 575-935-6262