Provider Demographics
NPI:1730971870
Name:DEUBLE, CRISTIN
Entity type:Individual
Prefix:
First Name:CRISTIN
Middle Name:
Last Name:DEUBLE
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 1:12 JUANITA LN
Mailing Address - Street 2:
Mailing Address - City:ALGODONES
Mailing Address - State:NM
Mailing Address - Zip Code:87001-8024
Mailing Address - Country:US
Mailing Address - Phone:801-647-1602
Mailing Address - Fax:
Practice Address - Street 1:51 BOSQUE RD
Practice Address - Street 2:
Practice Address - City:ALGODONES
Practice Address - State:NM
Practice Address - Zip Code:87001-8014
Practice Address - Country:US
Practice Address - Phone:505-639-9928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program