Provider Demographics
NPI:1487987962
Name:SMITH, JENNIFER J
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:J
Other - Last Name:JOHNSTONE-SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:6721 ACADEMY RD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3393
Mailing Address - Country:US
Mailing Address - Phone:505-944-6927
Mailing Address - Fax:505-342-4416
Practice Address - Street 1:3900 OSUNA RD NE
Practice Address - Street 2:SUITE 245 AND 222
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4459
Practice Address - Country:US
Practice Address - Phone:505-344-2877
Practice Address - Fax:505-342-4416
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM600724101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor