Provider Demographics
NPI:1699907543
Name:ANAYA, JACQUELINE (LMFT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:ANAYA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 WILSHIRE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1950
Mailing Address - Country:US
Mailing Address - Phone:505-443-1000
Mailing Address - Fax:
Practice Address - Street 1:5501 WILSHIRE AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1950
Practice Address - Country:US
Practice Address - Phone:054-435-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0110821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist