Individual
MISS JESSICA LYNN CONWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, MA
Contact information
Practice address
73 CUCHARA AVE E, LA VETA, CO 81055-9783
(719) 237-7077
Mailing address
PO BOX 2506, TAOS, NM 87571-2506
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC.0020536
CO
Other
Enumeration date
05/29/2024
Last updated
06/05/2024
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