Trace Julius Dudley

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CTB-2023-0403 Issued in NM

Practice address

4733 Jessica Dr NE
Rio Rancho, NM 87144-0853

Phone

(505) 537-9725

NPI assigned

May 22, 2023

Last updated

May 24, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• TJ Dudley Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1205528155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1037 WATERSTONE PARK CIR",
            "city": "HILLSBOROUGH",
            "state": "NC",
            "postal_code": "272789888",
            "telephone_number": "252-702-3026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4733 JESSICA DR NE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871440853",
            "telephone_number": "505-537-9725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDLEY",
        "first_name": "TRACE",
        "middle_name": "JULIUS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-22",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CTB-2023-0403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TJ",
            "last_name": "DUDLEY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Mental Health Counselor in Rio Rancho, NM
• Providers in Rio Rancho, NM by specialty
• Mental Health Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.