Healthcare Provider Details

I. General information

NPI: 1225910128
Provider Name (Legal Business Name): JORDAN SKEEN-BILGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 MENAUL BLVD NE
ALBUQUERQUE NM
87112-2435
US

IV. Provider business mailing address

300 MENAUL BLVD NW STE A236
ALBUQUERQUE NM
87107-1322
US

V. Phone/Fax

Practice location:
  • Phone: 505-526-3649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2025-0076
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: