Healthcare Provider Details

I. General information

NPI: 1578783908
Provider Name (Legal Business Name): SUSAN ANNE HONORE JEAN-PIERRE M.A., L.M.H.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ADAMS ST SE
ALBUQUERQUE NM
87108-2837
US

IV. Provider business mailing address

324 ADAMS ST SE
ALBUQUERQUE NM
87108-2837
US

V. Phone/Fax

Practice location:
  • Phone: 505-969-5999
  • Fax:
Mailing address:
  • Phone: 505-969-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3420
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: