Healthcare Provider Details

I. General information

NPI: 1396380176
Provider Name (Legal Business Name): JENNIFER JEAN REX MCNAIR LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 HERMOSA DR SE
ALBUQUERQUE NM
87108-4312
US

IV. Provider business mailing address

8409 SCARLET PL NW
ALBUQUERQUE NM
87120-5300
US

V. Phone/Fax

Practice location:
  • Phone: 505-237-0061
  • Fax:
Mailing address:
  • Phone: 505-977-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: