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General NPI Number Information
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NPI Number | 1295692614
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Entity Type | Individual
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Provider Name | STEPHEN KENT JUDY LSAA
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Gender | Male
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 2300 YALE BLVD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4273
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Country | US
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Telephone | 505-304-2812
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Fax |
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Provider Business Mailing Address
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Address Line | 1 LOS RANCHOS RD UNIT 4
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City | LOS LUNAS
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State | NM
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Zip | 87031-8967
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Country | US
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Telephone | 505-919-9681
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Fax | 505-919-9681
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CTB-2025-0947
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License Number State | NM
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