Healthcare Provider Details

I. General information

NPI: 1891073466
Provider Name (Legal Business Name): JASPER AND ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 E 20TH ST SUITE 104
FARMINGTON NM
87402-4411
US

IV. Provider business mailing address

PO BOX 3602
FARMINGTON NM
87499-3602
US

V. Phone/Fax

Practice location:
  • Phone: 505-326-0241
  • Fax: 505-325-8356
Mailing address:
  • Phone: 505-326-0241
  • Fax: 505-325-8356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: RHONDA HOFFMAN
Title or Position: OFFICE CONSULTANT
Credential:
Phone: 505-326-0241