Provider Demographics
NPI:1215250212
Name:RUST-HUERTA, JUDY ELLEN (LISW)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ELLEN
Last Name:RUST-HUERTA
Suffix:
Gender:F
Credentials:LISW
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 23
Mailing Address - Street 2:1100 SOARING EAGLE CT.
Mailing Address - City:CHROMO
Mailing Address - State:CO
Mailing Address - Zip Code:81128-0023
Mailing Address - Country:US
Mailing Address - Phone:970-264-9203
Mailing Address - Fax:
Practice Address - Street 1:610 ALTA VISTA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4149
Practice Address - Country:US
Practice Address - Phone:505-467-2504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-070201041C0700X
NM3289871041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool