Provider Demographics
NPI:1215244298
Name:JENNIFER MCCASH INC.
Entity type:Organization
Organization Name:JENNIFER MCCASH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCASH
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-203-8953
Mailing Address - Street 1:301 GRACELAND DR SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2778
Mailing Address - Country:US
Mailing Address - Phone:505-203-8953
Mailing Address - Fax:505-344-8677
Practice Address - Street 1:301 GRACELAND DR SE
Practice Address - Street 2:SUITE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2778
Practice Address - Country:US
Practice Address - Phone:505-203-8953
Practice Address - Fax:505-344-8677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-11
Last Update Date:2010-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-05551251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health