Individual
JILL M TIEDEMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
1601A SAINT MICHAELS DR, SANTA FE, NM 87505-7614
(505) 954-8777
(505) 954-8793
Mailing address
1601A SAINT MICHAELS DR, SANTA FE, NM 87505-7614
(505) 954-8777
(505) 954-8793
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
T3476
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NM600536
VALUE OPTIONS
NM
Enumeration date
07/12/2006
Last updated
07/08/2007
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