Healthcare Provider Details

I. General information

NPI: 1881928406
Provider Name (Legal Business Name): RACHEL JARVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE SUITE 28400
ALBUQUERQUE NM
87124
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-253-3000
  • Fax: 505-253-3001
Mailing address:
  • Phone: 505-253-3000
  • Fax: 505-253-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0145721
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: