Provider Demographics
NPI:1487996740
Name:NUTT, JUSTIN DEAN (LSCSW, LCSW, LCSW,-S)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:DEAN
Last Name:NUTT
Suffix:
Gender:M
Credentials:LSCSW, LCSW, LCSW,-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4750
Mailing Address - Country:US
Mailing Address - Phone:575-935-6262
Mailing Address - Fax:
Practice Address - Street 1:321 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4750
Practice Address - Country:US
Practice Address - Phone:575-935-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS85641041C0700X
1041C0700X
NMC-108551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical