=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487987962
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. JENNIFER J. SMITH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2009
-----------------------------------------------------
Last Update Date | 09/15/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 OSUNA RD NE SUITE 245 AND 222
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87109-4459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-344-2877
-----------------------------------------------------
Fax | 505-342-4416
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6721 ACADEMY RD NE SUITE A
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87109-3393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-944-6927
-----------------------------------------------------
Fax | 505-342-4416
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | NM600724
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------