Provider Demographics
NPI:1720472194
Name:MOORE - HUNDLEY, VANESSA KAY
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:KAY
Last Name:MOORE - HUNDLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-5529
Mailing Address - Country:US
Mailing Address - Phone:575-393-3168
Mailing Address - Fax:575-397-4659
Practice Address - Street 1:315 N 1ST ST
Practice Address - Street 2:
Practice Address - City:LOVINGTON
Practice Address - State:NM
Practice Address - Zip Code:88260-3630
Practice Address - Country:US
Practice Address - Phone:575-393-3168
Practice Address - Fax:575-397-4659
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0172761101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional