Individual
MR. JACK S SIAMU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS LPC
Contact information
Practice address
6301 CENTRAL AVE NW, ALBUQUERQUE, NM 87105-2036
(505) 352-3441
(505) 352-3400
Mailing address
6301 CENTRAL AVE NW, ALBUQUERQUE, NM 87105-2036
(505) 352-3441
(505) 352-3400
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1770
NM
Other
Enumeration date
09/25/2009
Last updated
09/25/2009
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