Active NPI
Jessica Caldera, MST
- Mental Health Counselor
- Clovis, NM
National Provider Identifier
1194058164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 01369101
- Practice address
- 1621 Sutter Place
Clovis, NM 88101 - Phone
- (575) 742-2620
- Fax
- (575) 742-3182
- NPI assigned
- Sep 9, 2009
- Last updated
- Mar 17, 2015
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | NU | ||
| Mental Health Counselor | 101YM0800X | 01369101 | NM | Primary |
Addresses
Primary practice location
1621 Sutter Place
Clovis, NM 88101
Mailing address
1100 W. 21St
Clovis, NM 88101
Phone (575) 769-2345
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| L7904 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01369101 | NM | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426550400000",
"number": "1194058164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 W. 21ST",
"city": "CLOVIS",
"state": "NM",
"postal_code": "88101",
"telephone_number": "575-769-2345",
"fax_number": "575-769-9013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1621 SUTTER PLACE",
"city": "CLOVIS",
"state": "NM",
"postal_code": "88101",
"telephone_number": "575-742-2620",
"fax_number": "575-742-3182"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALDERA",
"first_name": "JESSICA",
"credential": "MST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-09",
"last_updated": "2015-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NM",
"license": "01369101",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "L7904",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clovis, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.