Individual
DR. JILL WENDY HOLTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY
Contact information
Practice address
54 ST. MICHAELS DR. STE 200, SANTA FE, NM 87505-7602
(505) 303-5000
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
10091
NE
103TC0700X
Clinical Psychologist
1514
NM
103TC0700X
Clinical Psychologist
Primary
PSY1514
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
Other
Enumeration date
05/27/2015
Last updated
06/13/2022
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