Healthcare Provider Details

I. General information

NPI: 1609980325
Provider Name (Legal Business Name): JAN STONE M.A., L.P.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAN STONE M.A., L.P.C.C..

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7418 GETTYSBURG RD NE
ALBUQUERQUE NM
87109-5026
US

IV. Provider business mailing address

PO BOX 94976
ALBUQUERQUE NM
87199-4976
US

V. Phone/Fax

Practice location:
  • Phone: 505-610-9214
  • Fax:
Mailing address:
  • Phone: 505-610-9214
  • Fax: 505-332-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0109281
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: