Healthcare Provider Details

I. General information

NPI: 1124320361
Provider Name (Legal Business Name): JESSICA WERLING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 GRIEGOS RD NW
ALBUQUERQUE NM
87107-3752
US

IV. Provider business mailing address

8400 VISTA CLARA LN SW
ALBUQUERQUE NM
87121-8976
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-8471
  • Fax:
Mailing address:
  • Phone: 505-702-7459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0134941
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: