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NPI Code Detail

MEDICARE: JUMPSTART, LLC

MEDICARE: JUMPSTART, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC2200XClinical Child & Adolescent Psychologist0877NM
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1225206105
Entity Type Code : Organization
Provider Name (Legal Business Name) : JUMPSTART, LLC
Provider Business Mailing Address
First Line : 8100 M4 WYOMING NE #406
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87113-6615
Country : US
Telephone Number : 505-828-3837
Fax Number : 877-182-8550
Provider Business Practice Location Address
First Line : 8500 WASHINGTON ST NE STE A1
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87113-1861
Country : US
Telephone Number : 505-828-3837
Fax Number : 877-828-1550
Authorized Official
Title or Position : MANAGING MEMBER
Name : BRIAN LOPEZ
Credential : PHD
Telephone Number : 505-828-3837
Provider Enumeration Date : 02/13/2008
Last Update Date : 08/22/2024

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Directions to “JUMPSTART, LLC ” Practice Location

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