Healthcare Provider Details

I. General information

NPI: 1467026807
Provider Name (Legal Business Name): JORDAN REDMOND LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RIO GRANDE BLVD NW STE H160
ALBUQUERQUE NM
87104-2063
US

IV. Provider business mailing address

6004 ACADEMY RD NE
ALBUQUERQUE NM
87109-3306
US

V. Phone/Fax

Practice location:
  • Phone: 910-604-2991
  • Fax:
Mailing address:
  • Phone: 877-727-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2024-0665
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: