Organization
OUTSIDE THE BOX COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER NELSON LCSW (THERAPIST)
(505) 750-0105
Entity
Organization
Contact information
Practice address
4 AUDRA LOOP, ESTANCIA, NM 87016
(505) 750-0105
Mailing address
PO BOX 1080, ESTANCIA, NM 87016-1080
(505) 750-0105
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39077560
—
NM
Enumeration date
12/13/2021
Last updated
05/11/2022
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