Healthcare Provider Details

I. General information

NPI: 1740297100
Provider Name (Legal Business Name): JAN K HOLLINGSWORTH LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9631 MORROW AVE NE
ALBUQUERQUE NM
87112-2951
US

IV. Provider business mailing address

9631 MORROW AVE NE
ALBUQUERQUE NM
87112-2951
US

V. Phone/Fax

Practice location:
  • Phone: 505-275-2584
  • Fax:
Mailing address:
  • Phone: 505-275-2584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0803
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: