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General NPI Number Information
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NPI Number | 1205317047
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Entity Type | Individual
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Provider Name | JENNIFER L BEAR LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 08/28/2018
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Provider Practice Location Address
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Address Line | 2632 PENNSYLVANIA ST NE STE E
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City | ALBUQUERQUE
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State | NM
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Zip | 87110
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Country | US
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Telephone | 242-440-0505
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Fax |
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Provider Business Mailing Address
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Address Line | 2809 PALO VERDE DR NE APT B
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2142
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Country | US
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Telephone | 727-465-4555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | T-CTL0198901
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License Number State | NM
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