Healthcare Provider Details

I. General information

NPI: 1184675662
Provider Name (Legal Business Name): JUDY LYNN HINE VARGAS LISW LCSW LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDY LYNN HINE VARGAS LCSW LPCC

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 DON FERNANDO ST
TAOS NM
87571-5953
US

IV. Provider business mailing address

314 DON FERNANDO ST
TAOS NM
87571-5953
US

V. Phone/Fax

Practice location:
  • Phone: 575-751-7037
  • Fax:
Mailing address:
  • Phone: 575-751-7037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0078031
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0078031
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI05887
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC05887
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: