DR. NICOLE PHOENIX ANDERSON PHD NPI 1730126343

NPI Information

  • NPI: 1730126343
  • Provider Name: DR. NICOLE PHOENIX ANDERSON, PHD
  • Classification: Psychologist - 103TC0700X
  • Specialization: Clinical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 6501 4TH ST NW
    F4
    LOS RANCHOS, NM
    ZIP 87107
  • Phone: (505) 344-9641

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NPI Details

DR. Nicole Phoenix Anderson, PHD is a clinical psychologist in Los Ranchos, NM with 25 years of experience. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. DR. Nicole Phoenix Anderson, PHD NPI is 1730126343. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

6501 4TH ST NW
F4
LOS RANCHOS, NM
ZIP 87107-800
Phone: (505) 344-9641
Fax: (505) 344-2621

The NPI 1730126343 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Psychiatric diagnostic evaluation (HCPCS:90791)
  • Psychotherapy, 30 minutes (HCPCS:90832)

The enumeration date for this NPI number is 6/1/2006 and was last updated on 6/20/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TC0700XPsychologistClinical0976NEW MEXICOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
139703754MEDICAIDNEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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