Provider Demographics
NPI:1609861269
Name:THUMM-BOCHENSKI, JEAN EVA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:EVA
Last Name:THUMM-BOCHENSKI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:EVA
Other - Last Name:THUMM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:30 ESTAMBRE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8769
Mailing Address - Country:US
Mailing Address - Phone:505-466-4990
Mailing Address - Fax:505-466-4990
Practice Address - Street 1:30 ESTAMBRE RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8769
Practice Address - Country:US
Practice Address - Phone:505-466-4990
Practice Address - Fax:505-466-4990
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
NM4349106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMVNM00057Medicaid