Provider Demographics
NPI:1912023029
Name:FRANCHELL, JERILYN GROUT (MC, LSC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JERILYN
Middle Name:GROUT
Last Name:FRANCHELL
Suffix:
Gender:F
Credentials:MC, LSC, LMFT
Other - Prefix:
Other - First Name:JAYE
Other - Middle Name:
Other - Last Name:FRANCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4340 LOS METATES RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5306
Mailing Address - Country:US
Mailing Address - Phone:505-897-2349
Mailing Address - Fax:
Practice Address - Street 1:2612 TEXAS ST NE
Practice Address - Street 2:STE. S-14
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4684
Practice Address - Country:US
Practice Address - Phone:505-489-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0089751106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist