Provider Demographics
NPI:1902469596
Name:KIRKPATRICK, JOWANNA PEARL (LMHC)
Entity Type:Individual
Prefix:
First Name:JOWANNA
Middle Name:PEARL
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 EXECUTIVE HILLS RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4718
Mailing Address - Country:US
Mailing Address - Phone:575-491-1918
Mailing Address - Fax:
Practice Address - Street 1:1909 CUBA AVE STE 5
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5646
Practice Address - Country:US
Practice Address - Phone:575-489-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0203511101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health