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General NPI Number Information
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NPI Number | 1487936936
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Entity Type | Individual
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Provider Name | JEANNE C CETRULO LPCC
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Gender | Female
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Dates
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Enumeration Date | 09/11/2011
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Last Update Date | 04/22/2023
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Provider Practice Location Address
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Address Line | 217 PASEO DEL PUEBLO NORTE STE E
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City | TAOS
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State | NM
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Zip | 87571-5963
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Country | US
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Telephone | 575-825-3522
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16199
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City | LAS CRUCES
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State | NM
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Zip | 88004-6199
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Country | US
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Telephone | 575-527-5770
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Fax | 575-532-1928
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0142621
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License Number State | NM
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