Individual
JAMIE CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
530 DE MOSS ST, LORDSBURG, NM 88045-2618
(575) 542-2369
Mailing address
530 DE MOSS ST, LORDSBURG, NM 88045-2618
(575) 542-2369
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CTB-2022-0048
NM
176B00000X
Midwife
466
CA
Other
Enumeration date
04/07/2016
Last updated
04/12/2022
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