| Jenna Koors, Llc | |
|
20 Kelly Lynn Dr Sandia Park NM 87047-9326 | |
| (505) 363-9373 | |
| Not Available |
| Full Name | Jenna Koors, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 20 Kelly Lynn Dr, Sandia Park, New Mexico |
| Authorized Official Name and Position | Jenna Marie Koors (PSYCHOTHERAPIST/CEO) |
| Authorized Official Contact | 5053639373 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jenna Koors, Llc 20 Kelly Lynn Dr Sandia Park NM 87047-9326 Ph: (505) 363-9373 | Jenna Koors, Llc 20 Kelly Lynn Dr Sandia Park NM 87047-9326 Ph: (505) 363-9373 |
| NPI Number | 1801620729 |
|---|---|
| Provider Enumeration Date | 09/02/2024 |
| Last Update Date | 09/02/2024 |
| Certification Date | 09/01/2024 |
| Medicare PECOS PAC ID | 1759818727 |
|---|---|
| Medicare Enrollment ID | O20250102003456 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801620729 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jenna Marie Koors |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992181416 PECOS PAC ID: 2668909631 Enrollment ID: I20250102003511 |
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