Provider Demographics
NPI:1518128206
Name:LINDSEY, JEREMY TAYLOR (LMFT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:TAYLOR
Last Name:LINDSEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 VANDEN BOSCH PKWY
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5508
Mailing Address - Country:US
Mailing Address - Phone:505-726-6910
Mailing Address - Fax:505-722-6192
Practice Address - Street 1:650 VANDEN BOSCH PKWY
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5508
Practice Address - Country:US
Practice Address - Phone:505-726-6910
Practice Address - Fax:505-722-6192
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0064671106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist