Healthcare Provider Details

I. General information

NPI: 1962530121
Provider Name (Legal Business Name): NANCY N SALLEE PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 MISSOURI AVE
LAS CRUCES NM
88001-5327
US

IV. Provider business mailing address

1395 MISSOURI AVE
LAS CRUCES NM
88001-5327
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-5466
  • Fax: 575-521-8611
Mailing address:
  • Phone: 575-522-5466
  • Fax: 575-521-8611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number521
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: