Provider Demographics
NPI:1952637571
Name:JACKS, FELIPITA CHRISTINA (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:FELIPITA
Middle Name:CHRISTINA
Last Name:JACKS
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:FELIPITA
Other - Middle Name:CHRISTINA
Other - Last Name:JACKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:319 LOS PINOS RD
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-6505
Mailing Address - Country:US
Mailing Address - Phone:505-319-9591
Mailing Address - Fax:
Practice Address - Street 1:319 LOS PINOS RD
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6505
Practice Address - Country:US
Practice Address - Phone:505-319-9591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor