Provider Demographics
NPI:1346417490
Name:UDALL, DANA (PHD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:UDALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MICHELLE
Other - Last Name:UDALL-WEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1301 LUISA ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7001
Mailing Address - Country:US
Mailing Address - Phone:505-573-6223
Mailing Address - Fax:
Practice Address - Street 1:1301 LUISA ST
Practice Address - Street 2:SUITE E
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7001
Practice Address - Country:US
Practice Address - Phone:505-573-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1047103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling