Roberto Perez Jacquez, LPCC
Individual provider Active NPI Professional Counselor · Chamberino, NM
NPI 1992901797 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992901797
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 006091 (NM)
- Practice address
- 515 E. Lara Road
Chamberino, NM 88027-0307 - Phone
- (505) 644-2452
- NPI assigned
- Jun 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 006091 | NM | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 006091 | NM | Yes |
Addresses
Primary practice location
515 E. Lara Road
Chamberino, NM 88027-0307
Mailing address
PO Box 307
Chamberino, NM 88027-0307
Phone (505) 644-2452
Other providers in Chamberino, NM
- Amneris Cruz
- Brisa Luvian
- Jose Luvian
- Pediatric Speak Easy, LLC
- Rancho Rios Dominguez
- Francisco Rodriguez Jr.
All providers in Chamberino, NM · Professional 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, 2007. 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.