Provider Demographics
NPI:1821410614
Name:JUDD, DONNA MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MICHELLE
Last Name:JUDD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 S 3RD ST STE 130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-5918
Mailing Address - Country:US
Mailing Address - Phone:702-485-4937
Mailing Address - Fax:702-749-5922
Practice Address - Street 1:400 SKY ROAD
Practice Address - Street 2:
Practice Address - City:INDIAN SPRINGS
Practice Address - State:NV
Practice Address - Zip Code:89018
Practice Address - Country:US
Practice Address - Phone:702-485-4937
Practice Address - Fax:702-749-5922
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health