Individual
JEANNE PROVENCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
505 S MAIN ST, STE. 129, LAS CRUCES, NM 88001-1206
(505) 525-5644
(505) 647-2010
Mailing address
505 S MAIN ST, STE. 129, LAS CRUCES, NM 88001-1206
(505) 525-5644
(505) 647-2010
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0529
NM
Other
Enumeration date
08/24/2005
Last updated
07/08/2007
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