Healthcare Provider Details

I. General information

NPI: 1447933908
Provider Name (Legal Business Name): NICOLE MORRIS-JUDD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 EAGLE CT
SANTO DOMINGO PUEBLO NM
87052-1230
US

IV. Provider business mailing address

8 COYOTE LOCO RD
SANTA FE NM
87508-6664
US

V. Phone/Fax

Practice location:
  • Phone: 505-465-2733
  • Fax:
Mailing address:
  • Phone: 505-270-0757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0302
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: