Provider Demographics
NPI:1467124347
Name:HUME, HEATHER CHRISTINE (CSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:CHRISTINE
Last Name:HUME
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 EL MOLINO BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2915
Mailing Address - Country:US
Mailing Address - Phone:575-914-2449
Mailing Address - Fax:575-629-6228
Practice Address - Street 1:350 EL MOLINO BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2915
Practice Address - Country:US
Practice Address - Phone:575-914-2449
Practice Address - Fax:575-629-6228
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0208221101YM0800X
NM171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM11226005Medicaid