Healthcare Provider Details

I. General information

NPI: 1679258354
Provider Name (Legal Business Name): CONSCIOUS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 VAL VERDE DR
SANTA FE NM
87508-4619
US

IV. Provider business mailing address

5 VAL VERDE DR
SANTA FE NM
87508-4619
US

V. Phone/Fax

Practice location:
  • Phone: 210-313-1760
  • Fax:
Mailing address:
  • Phone: 210-313-1760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LYNNE JACKSON
Title or Position: OWNER
Credential: LCSW
Phone: 210-313-1760