Provider Demographics
NPI:1962530121
Name:SALLEE, NANCY N (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:N
Last Name:SALLEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5327
Mailing Address - Country:US
Mailing Address - Phone:575-522-5466
Mailing Address - Fax:575-521-8611
Practice Address - Street 1:1395 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5327
Practice Address - Country:US
Practice Address - Phone:575-522-5466
Practice Address - Fax:575-521-8611
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM521103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1962530121OtherNATIONAL PROVIDER IDENTIFIER NUMBER
NM601013663OtherPRESBYTERIAN/MAGELLAN
NM920579500OtherBLUE CROSS BLUE SHIELD
NM434659OtherPTAN (MEDICARE NOVITAS)
13507182OtherCAQH
NM220147OtherEDUCATIONAL PSYCHOLOGIST IIIA
NM000N8486Medicaid