Individual
JENNIFER L REAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
2600 MARBLE NE, ALBUQUERQUE, NM 87131-0001
(505) 272-2190
Mailing address
9016 LOS ARBOLES AVE NE, ALBUQUERQUE, NM 87112-1269
(505) 332-0817
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
I-3305
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000L1672
—
NM
Enumeration date
11/14/2005
Last updated
07/19/2023
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