Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 334 | NM |
Y | 103T00000X | Psychologist | 334 | NM |
NPI | 1013014117 |
---|---|
Provider Name | Dr. Helen Lamar Jackson |
First Address | Albuquerque, NM 87110-6738 |
Second Address | Albuquerque, NM 87110-6738 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
N9626 | (05) | NM |