Healthcare Provider Details

I. General information

NPI: 1376159764
Provider Name (Legal Business Name): JESSICA ASHLEY SCHREIER KENNARD MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 11/27/2023
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9741 CANDELARIA RD NE
ALBUQUERQUE NM
87112-1401
US

IV. Provider business mailing address

2703 FLORAL RD NW
ALBUQUERQUE NM
87104-1927
US

V. Phone/Fax

Practice location:
  • Phone: 505-252-3285
  • Fax:
Mailing address:
  • Phone: 505-974-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0212071
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: