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General NPI Number Information
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NPI Number | 1801620729
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Entity Type | Organization
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Legal Business Name | JENNA KOORS, LLC
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Dates
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Enumeration Date | 09/02/2024
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Last Update Date | 09/02/2024
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Provider Practice Location Address
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Address Line | 20 KELLY LYNN DR
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City | SANDIA PARK
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State | NM
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Zip | 87047-9326
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Country | US
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Telephone | 505-363-9373
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Fax |
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Provider Business Mailing Address
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Address Line | 20 KELLY LYNN DR
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City | SANDIA PARK
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State | NM
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Zip | 87047-9326
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Country | US
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Telephone | 505-363-9373
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST/CEO
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Name | MISS JENNA MARIE KOORS
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Credential | LCSW
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Telephone | 505-363-9373
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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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