Healthcare Provider Details

I. General information

NPI: 1831409259
Provider Name (Legal Business Name): GERRY ANN JUCHNIEWICZ LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 WYOMING BLVD NE
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

5737 PEPPERTREE PLACE NE
ALBUQUERQUE NM
87111
US

V. Phone/Fax

Practice location:
  • Phone: 505-515-4124
  • Fax:
Mailing address:
  • Phone: 505-296-2406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number005540
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005540
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number005540
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number005540
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: