Healthcare Provider Details

I. General information

NPI: 1891655791
Provider Name (Legal Business Name): JESSICA WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 BARBARA LOOP SE STE A2
RIO RANCHO NM
87124-1372
US

IV. Provider business mailing address

217 COYOTE TRL
CORRALES NM
87048-7543
US

V. Phone/Fax

Practice location:
  • Phone: 505-225-3194
  • Fax: 505-212-6336
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: