Active NPI
Jill Regina Dougherty, MA, LPCC
- Professional Counselor
- Rio Rancho, NM
National Provider Identifier
1104912930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0122691
- Practice address
- 1800 35TH Street, SE
Rio Rancho, NM 87124 - Phone
- (505) 892-8640
- Fax
- (505) 892-4658
- NPI assigned
- Oct 5, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 0099771 | NM | |
| Professional Counselor | 101YP2500X | 0122691 | NM | Primary |
Addresses
Primary practice location
1800 35TH Street, SE
Rio Rancho, NM 87124
Mailing address
1800 35TH Street, SE
Rio Rancho, NM 87124
Phone (505) 892-8640
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0099771 | NM | MD | Mental Health Counselor |
| 0122691 | NM | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242345600000",
"number": "1104912930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 35TH STREET, SE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "87124",
"telephone_number": "505-892-8640",
"fax_number": "505-892-4658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 35TH STREET, SE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "87124",
"telephone_number": "505-892-8640",
"fax_number": "505-892-4658"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGHERTY",
"first_name": "JILL",
"middle_name": "REGINA",
"name_prefix": "Ms.",
"credential": "MA, LPCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-05",
"last_updated": "2009-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NM",
"license": "0099771",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NM",
"license": "0122691",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rio Rancho, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.