Healthcare Provider Details

I. General information

NPI: 1720492341
Provider Name (Legal Business Name): TERRI LYNN KIDD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 N MOTEL BLVD
LAS CRUCES NM
88007-4169
US

IV. Provider business mailing address

385 CALLE DE ALEGRA BLDG A
LAS CRUCES NM
88005-3423
US

V. Phone/Fax

Practice location:
  • Phone: 575-527-7975
  • Fax: 575-674-2891
Mailing address:
  • Phone: 575-526-1105
  • Fax: 575-524-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29417
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-1083
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: