Provider Demographics
NPI:1508418013
Name:THORDSEN MONROY, JAMIE ANNE (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ANNE
Last Name:THORDSEN MONROY
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 SPRUCE ST STE C AND D
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-3455
Mailing Address - Country:US
Mailing Address - Phone:505-747-7400
Mailing Address - Fax:
Practice Address - Street 1:835 SPRUCE ST STE C AND D
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3455
Practice Address - Country:US
Practice Address - Phone:505-747-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0206251101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor