Provider Demographics
NPI:1144788191
Name:BLOUNT, JENNIFER (LPCC, NCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 SEAGULL ST NE STE B205
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2500
Mailing Address - Country:US
Mailing Address - Phone:505-312-8324
Mailing Address - Fax:
Practice Address - Street 1:6100 SEAGULL ST NE STE B205
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2500
Practice Address - Country:US
Practice Address - Phone:505-312-8324
Practice Address - Fax:505-856-7946
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-CTL0201981101YM0800X
NMCCMH0221351101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health