Individual
JACKIE MYRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
7027 MONTGOMERY BLVD NE, SUITE F, ALBUQUERQUE, NM 87109-1589
(505) 880-0100
Mailing address
7027 MONTGOMERY BLVD NE, SUITE F, ALBUQUERQUE, NM 87109-1589
(505) 880-0100
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4506
NM
Other
Enumeration date
12/05/2007
Last updated
12/05/2007
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