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General NPI Number Information
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NPI Number | 1780221564
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Entity Type | Individual
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Provider Name | JACQUELINE NICHOLE MUNIZ MS
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Gender | Female
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Dates
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Enumeration Date | 11/29/2019
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 318 27 3/8 ROAD
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City | GRAND JCT
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State | CO
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Zip | 81503-2054
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Country | US
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Telephone | 970-312-4318
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Fax |
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Provider Business Mailing Address
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Address Line | 3147 HALLMARK PL
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City | GRAND JUNCTION
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State | CO
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Zip | 81504-6044
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Country | US
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Telephone | 970-261-3335
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Fax |
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT.0002639
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License Number State | CO
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