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General NPI Number Information
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NPI Number | 1366588642
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Entity Type | Organization
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Legal Business Name | JEANINE FORSYTHE INC.
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10601 LOMAS BLVD NE STE 108
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-5462
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Country | US
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Telephone | 505-293-0617
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Fax | 505-293-0617
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Provider Business Mailing Address
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Address Line | 10601 LOMAS BLVD NE STE 108
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-5462
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Country | US
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Telephone | 505-293-0617
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Fax | 505-293-0617
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. JEANINE M FORSYTHE
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Credential | M.A., LPCC,CCFC,CCJS
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Telephone | 505-453-7307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1993
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License Number State | NM
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