Healthcare Provider Details

I. General information

NPI: 1528499548
Provider Name (Legal Business Name): JENALEE GARCIA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2013
Last Update Date: 12/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8804 VALLEJO PL NE
ALBUQUERQUE NM
87122-2631
US

IV. Provider business mailing address

1701 ARIZONA AVE
LAS CRUCES NM
88001-3911
US

V. Phone/Fax

Practice location:
  • Phone: 575-621-8320
  • Fax:
Mailing address:
  • Phone: 575-621-8320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0162681
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: