Individual
JESSICA LEE EDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC, CHW
Contact information
Practice address
3949 CORRALES RD STE 205, CORRALES, NM 87048-9348
(505) 385-0439
Mailing address
PO BOX 521, CEDAR CREST, NM 87008-0521
(720) 471-9752
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CTB-2024-0650
NM
Other
Enumeration date
10/21/2024
Last updated
10/21/2024
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