Doctor Name: | MRS. JENNIFER JOHN CHARLEY |
NPI Number: | 1659735140 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LADAC |
License Number: | 0119271 |
Business Practice Address: | 15 Behavioral Health Rd Pinehill, NM - 87357 |
Business Phone Number: | 5057753353 |
Business Fax Number: | 5057753630 |
Mailing Address: | Po Box 490, PINEHILL |
State: | NM |
Postal Code: | 873570490 |
Phone Number: | 5057753353 |
Fax Number: | 5057753630 |
NPI Enumeration Date: | 04/11/2016 |
NPI Last Update Date: | 04/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 0119271 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |