=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457892465
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J DOWD COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2017
-----------------------------------------------------
Last Update Date | 03/10/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 514 MONROE STREET SE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-358-1904
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10474 CAPRICORN PLACE NW
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87114-3404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-358-1904
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER-OPERATOR/LPCC
-----------------------------------------------------
Name | JOAN FRANCES DOWD
-----------------------------------------------------
Credential | MA, LPCC
-----------------------------------------------------
Telephone | 505-358-1904
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0164851
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 0164851
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------