Healthcare Provider Details

I. General information

NPI: 1699703199
Provider Name (Legal Business Name): BARRY KENT HUGHES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W GRIGGS AVE
LAS CRUCES NM
88001-1234
US

IV. Provider business mailing address

5015 NOCHE BELLA LOOP
LAS CRUCES NM
88011-2505
US

V. Phone/Fax

Practice location:
  • Phone: 505-647-2852
  • Fax:
Mailing address:
  • Phone: 505-649-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number469
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: