Healthcare Provider Details

I. General information

NPI: 1619171055
Provider Name (Legal Business Name): JL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5516 OVERLOOK DR NE
ALBUQUERQUE NM
87111-1881
US

IV. Provider business mailing address

5516 OVERLOOK DR NE
ALBUQUERQUE NM
87111-1881
US

V. Phone/Fax

Practice location:
  • Phone: 505-235-4756
  • Fax: 505-831-2591
Mailing address:
  • Phone: 505-235-4756
  • Fax: 505-831-2591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI06070
License Number StateNM

VIII. Authorized Official

Name: MS. JOAN LYNNE LEVINE
Title or Position: OWNER
Credential: LISW
Phone: 505-831-2591