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General NPI Number Information
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NPI Number | 1487400214
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Entity Type | Organization
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Legal Business Name | JETZEN COUNSELING
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Dates
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Enumeration Date | 04/24/2024
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 508B W MCKAY ST
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City | CARLSBAD
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State | NM
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Zip | 88220-5067
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Country | US
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Telephone | 575-636-2468
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 ALBERT ST
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City | CARLSBAD
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State | NM
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Zip | 88220-4528
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Country | US
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Telephone | 575-302-7035
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | JOHNNA YEAGER
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Credential |
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Telephone | 575-302-7035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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