Healthcare Provider Details

I. General information

NPI: 1487396644
Provider Name (Legal Business Name): ALEXANDRA CRISMAN-JONES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 UPTOWN BLVD NE STE 305
ALBUQUERQUE NM
87110-4148
US

IV. Provider business mailing address

610 GOLD AVE SW STE 102
ALBUQUERQUE NM
87102-3187
US

V. Phone/Fax

Practice location:
  • Phone: 505-219-1125
  • Fax:
Mailing address:
  • Phone: 505-219-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2022-0067
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: