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NPI Code Detail

MEDICARE: DR. JILL STRAITS PHD

MEDICARE: DR. JILL STRAITS PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist1226NM
2103TC2200XClinical Child & Adolescent Psychologist1226NM
3103T00000XPsychologist1226NM

General Provider Information

NPI Number : 1215160742
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JILL STRAITS PHD
Provider Business Mailing Address
First Line : PO BOX 10851
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87184-0851
Country : US
Telephone Number : 505-720-3371
Fax Number :
Provider Business Practice Location Address
First Line : 1317 ISLETA BLVD SW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87105-4035
Country : US
Telephone Number : 505-312-7296
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2009
Last Update Date : 02/18/2013

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