ADDRESS CHANGE REQUEST

61-23-20, NMSA 1978 mandates, “D. Each licensee shall have the responsibility to notify the board of any change of address.”

To submit an address change request, please fill out the form below. You may also print and mail the form to the Board Office.  Download the form Address Change Request

Note: Please check the box which you prefer as your mailing address. Licensee’s preferred mailing address will appear on the roster.

Online Address Change Request Form

License/Certification Designation

Not Certified nor Licensed

New Business Address

New Home Address

3 + 12 =