Healthcare Provider Details

I. General information

NPI: 1437940376
Provider Name (Legal Business Name): TYRA MONET JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 WHITEMAN DR NW
ALBUQUERQUE NM
87120-2196
US

IV. Provider business mailing address

3150 CARLISLE BLVD NE STE 105
ALBUQUERQUE NM
87110-1680
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-1155
  • Fax: 505-717-1473
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2026-0204
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: