Provider Demographics
NPI:1861368698
Name:LUTHER, JESSICA (MA, IMH-E)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LUTHER
Suffix:
Gender:F
Credentials:MA, IMH-E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-2836
Mailing Address - Country:US
Mailing Address - Phone:575-223-2585
Mailing Address - Fax:
Practice Address - Street 1:400 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-2836
Practice Address - Country:US
Practice Address - Phone:575-223-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker