1982813846 NPI number — JANICE L KIEHNE LICENSED MENTAL HEAL

Table of content: JANICE L KIEHNE LICENSED MENTAL HEAL (NPI 1982813846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982813846 NPI number — JANICE L KIEHNE LICENSED MENTAL HEAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIEHNE
Provider First Name:
JANICE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICENSED MENTAL HEAL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982813846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1349
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER CITY
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88062-1349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-388-4497
Provider Business Mailing Address Fax Number:
575-534-1150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#1 FOSTER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RESERVE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-533-6649
Provider Business Practice Location Address Fax Number:
575-534-1150
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  0072471 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: 0072471 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 18728359 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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