Provider Demographics
NPI:1942675376
Name:JUDD, JAMES (CADCI)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:JUDD
Suffix:
Gender:M
Credentials:CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89803-2580
Mailing Address - Country:US
Mailing Address - Phone:775-738-4158
Mailing Address - Fax:775-753-6487
Practice Address - Street 1:3740 E IDAHO ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4611
Practice Address - Country:US
Practice Address - Phone:775-738-4158
Practice Address - Fax:775-753-6487
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCADCI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)