Provider Demographics
NPI:1720444664
Name:URBAN, JENNIFER A (LPCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:URBAN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 INDIAN SCHOOL RD NE APT D205
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3852
Mailing Address - Country:US
Mailing Address - Phone:505-573-4407
Mailing Address - Fax:
Practice Address - Street 1:1001 YALE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3825
Practice Address - Country:US
Practice Address - Phone:505-573-4407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0172631101YM0800X
NMCCMH0213981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health