Jessica Lynn Callaway, LPCC
Individual provider Active NPI Mental Health Counselor · Espanola, NM
NPI 1760615140 · NPPES record last updated Jul 8, 2010
Key facts
- NPI
- 1760615140
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 0132841 (NM)
- Practice address
- 1102 A Paseo de Onate
Espanola, NM 87532 - Phone
- (505) 852-1377
- Fax
- (505) 852-1378
- NPI assigned
- Sep 1, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0113441 | NM | MD | Mental Health Counselor |
| 0120981 | NM | MD | Mental Health Counselor |
| 0132841 | NM | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eight Northern Indian Pueblos Council, Inc. | Mental Health | Past | Accepting new patients |
| Eight Northern Indian Pueblos Council, Inc. | Mental Health | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 0120981 | NM | |
| Mental Health Counselor | 101YM0800X | 0113441 | NM | |
| Mental Health Counselor | 101YM0800X | 0132841 | NM | Yes |
Addresses
Primary practice location
1102 A Paseo de Onate
Espanola, NM 87532
Mailing address
1102 A Paseo de Onate
Espanola, NM 87532
Phone (505) 852-1377
Other providers in Espanola, NM
- Rudy Brown
- Desiree Bustos
- Rebecca Miran Cadden
- Karen M Cain
- Suzanne Call
- Brenda Cardozo
- Pamela Jeanne Carlson
- Lori Carmen
- Kayla Carrillo
- Angelica Casados
All providers in Espanola, NM · Mental Health Counselor in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.