Provider Demographics
NPI:1982802518
Name:COLLIN-SMITH, JEANNE ANN (LPCC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:ANN
Last Name:COLLIN-SMITH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:ANN LYONS
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT, LPCC
Mailing Address - Street 1:5340 VERONICA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1950
Mailing Address - Country:US
Mailing Address - Phone:505-855-9916
Mailing Address - Fax:505-294-0128
Practice Address - Street 1:2403 SAN MATEO BLVD NE
Practice Address - Street 2:SUITE W-10
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4058
Practice Address - Country:US
Practice Address - Phone:505-830-6500
Practice Address - Fax:505-830-6527
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1260101YP2500X
NM241066103TS0200X
CA16446106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist