Healthcare Provider Details

I. General information

NPI: 1144788191
Provider Name (Legal Business Name): JENNIFER BLOUNT LPCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 SEAGULL ST NE STE B205
ALBUQUERQUE NM
87109-2500
US

IV. Provider business mailing address

6100 SEAGULL ST NE STE B205
ALBUQUERQUE NM
87109-2500
US

V. Phone/Fax

Practice location:
  • Phone: 505-312-8324
  • Fax: 505-856-7946
Mailing address:
  • Phone: 505-312-8324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-CTL0201981
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0221351
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: