Healthcare Provider Details

I. General information

NPI: 1215636493
Provider Name (Legal Business Name): JESSICA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S TELSHOR BLVD STE 201B
LAS CRUCES NM
88011-3647
US

IV. Provider business mailing address

6113 HIGH PLAINS RD
LAS CRUCES NM
88012-7255
US

V. Phone/Fax

Practice location:
  • Phone: 505-974-5890
  • Fax:
Mailing address:
  • Phone: 469-207-5789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: