Healthcare Provider Details

I. General information

NPI: 1710836903
Provider Name (Legal Business Name): JILL JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1710
US

IV. Provider business mailing address

36 CASA HERMOSA DR NE
ALBUQUERQUE NM
87112-7000
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-9911
  • Fax:
Mailing address:
  • Phone:
  • 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: