Provider Demographics
NPI:1740297100
Name:HOLLINGSWORTH, JAN K (LPCC)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:K
Last Name:HOLLINGSWORTH
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 1:9631 MORROW AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2951
Mailing Address - Country:US
Mailing Address - Phone:505-275-2584
Mailing Address - Fax:
Practice Address - Street 1:9631 MORROW AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2951
Practice Address - Country:US
Practice Address - Phone:505-275-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0803101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2202654OtherCIGNA LPCC PROVIDER
NM100626Medicaid
NM118824OtherVALUE OPTIONS COMMERCIAL
NMNM LICENSE # 0803OtherCLINICAL MH COUNSELOR