Healthcare Provider Details

I. General information

NPI: 1356259600
Provider Name (Legal Business Name): JERRY G PROCHAZKA LMHC, CRC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 EL MOLINO BLVD
LAS CRUCES NM
88005-2915
US

IV. Provider business mailing address

7046 CALLE ESTANCIAS
LAS CRUCES NM
88007-8803
US

V. Phone/Fax

Practice location:
  • Phone: 575-323-8900
  • Fax: 575-267-6228
Mailing address:
  • Phone: 575-640-6121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number746111
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2026-0754
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: