Healthcare Provider Details

I. General information

NPI: 1902551690
Provider Name (Legal Business Name): BLUEJAY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 05/19/2024
Certification Date: 05/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 MONROE ST NE UNIT N139
ALBUQUERQUE NM
87110-1878
US

IV. Provider business mailing address

PO BOX 87
HOLMAN NM
87723-0087
US

V. Phone/Fax

Practice location:
  • Phone: 619-997-9637
  • Fax:
Mailing address:
  • Phone: 619-997-9637
  • 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: LAUREN HUNTER
Title or Position: OWNER
Credential:
Phone: 619-997-9637