Provider Demographics
NPI:1053715714
Name:PIERSON, JENNIFER PAIGE (LPC, LPCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PAIGE
Last Name:PIERSON
Suffix:
Gender:F
Credentials:LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:NM
Mailing Address - Zip Code:87567-0800
Mailing Address - Country:US
Mailing Address - Phone:505-692-5472
Mailing Address - Fax:
Practice Address - Street 1:1200 N PASEO DE ONATE
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2687
Practice Address - Country:US
Practice Address - Phone:505-747-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69912101YM0800X
NM0188171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health