Provider Demographics
NPI:1710461975
Name:DUNNELL, JENNIE (LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:DUNNELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 CAMINO RINCON SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8842
Mailing Address - Country:US
Mailing Address - Phone:505-322-5856
Mailing Address - Fax:
Practice Address - Street 1:1941 CAMINO RINCON SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8842
Practice Address - Country:US
Practice Address - Phone:505-322-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-23
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-CTL0199261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health