Healthcare Provider Details

I. General information

NPI: 1801239660
Provider Name (Legal Business Name): JEANINE M FORSYTHE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANINE M MOREAU LPCC

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CARLISLE BLVD NE STE 225
ALBUQUERQUE NM
87110-1664
US

IV. Provider business mailing address

7850 JEFFERSON ST NE STE 300
ALBUQUERQUE NM
87109-4314
US

V. Phone/Fax

Practice location:
  • Phone: 505-453-7307
  • Fax: 505-293-0617
Mailing address:
  • Phone: 505-884-1114
  • Fax: 505-884-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0113011
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: