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General NPI Number Information
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NPI Number | 1871405886
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Entity Type | Individual
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Provider Name | JEANETTE DIAZ LMHC
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Gender | Female
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 6713 4TH ST NW
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City | LOS RANCHOS
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State | NM
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Zip | 87107-6114
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Country | US
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Telephone | 505-718-2119
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Fax | 505-944-1953
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Provider Business Mailing Address
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Address Line | 6411 CANAVIO PL NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-7052
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Country | US
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Telephone | 505-718-2119
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Fax | 505-944-1953
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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 | CTB-2024-0241
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License Number State | NM
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