Provider Demographics
NPI:1750323580
Name:HUME, DONALD W (PHD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:HUME
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 FAIRWAY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-4803
Mailing Address - Country:US
Mailing Address - Phone:405-818-1505
Mailing Address - Fax:
Practice Address - Street 1:2455 MISSOURI AVE STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5122
Practice Address - Country:US
Practice Address - Phone:405-818-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK145103TC0700X
NMPSY-2023-0113103TC0700X
NM1306103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100842580AMedicaid
NM22639102Medicaid
NM58926577Medicaid
1306286588OtherNPI