Provider Demographics
NPI:1982813846
Name:KIEHNE, JANICE L (LICENSED MENTAL HEAL)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:KIEHNE
Suffix:
Gender:F
Credentials:LICENSED MENTAL HEAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1349
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-1349
Mailing Address - Country:US
Mailing Address - Phone:575-388-4497
Mailing Address - Fax:575-534-1150
Practice Address - Street 1:#1 FOSTER ROAD
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:NM
Practice Address - Zip Code:87830
Practice Address - Country:US
Practice Address - Phone:575-533-6649
Practice Address - Fax:575-534-1150
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0072471101Y00000X
NM0072471101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18728359Medicaid