Healthcare Provider Details

I. General information

NPI: 1467921544
Provider Name (Legal Business Name): JANN ELIZABETH JUSTICE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2018
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 GOLF COURSE RD SE STE D
RIO RANCHO NM
87124-1760
US

IV. Provider business mailing address

979 IVORY RD SE
RIO RANCHO NM
87124-3020
US

V. Phone/Fax

Practice location:
  • Phone: 505-419-8885
  • Fax: 505-212-0041
Mailing address:
  • Phone: 505-419-8885
  • Fax: 505-212-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberT-CT10198281
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: