Provider Demographics
NPI:1942327234
Name:HUMES, DUSTY LEE (PHD)
Entity Type:Individual
Prefix:MS
First Name:DUSTY
Middle Name:LEE
Last Name:HUMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SAN PEDRO DR NE
Mailing Address - Street 2:BUILDING 4, SUITE 102
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4133
Mailing Address - Country:US
Mailing Address - Phone:512-917-3126
Mailing Address - Fax:505-884-3230
Practice Address - Street 1:2201 SAN PEDRO DR NE
Practice Address - Street 2:BUILDING 4, SUITE 102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4133
Practice Address - Country:US
Practice Address - Phone:512-917-3126
Practice Address - Fax:505-884-3230
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4275103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX-24275OtherPSYCHOLOGY LICENSE
NMNM-1213OtherPSYCHOLOGY LICENSE