| 32 Degrees Genuine, Llc | |
|
5701 Carmel Ave Ne Ste B Albuquerque NM 87113-2843 | |
| (505) 308-5226 | |
| (505) 514-0754 |
| Full Name | 32 Degrees Genuine, Llc |
|---|---|
| Speciality | Counselor |
| Location | 5701 Carmel Ave Ne Ste B, Albuquerque, New Mexico |
| Authorized Official Name and Position | Jessica R Johnson (THERAPIST/OWNER) |
| Authorized Official Contact | 5055956622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 32 Degrees Genuine, Llc 5701 Carmel Ave Ne Ste B Albuquerque NM 87113-2843 Ph: (505) 595-6622 | 32 Degrees Genuine, Llc 5701 Carmel Ave Ne Ste B Albuquerque NM 87113-2843 Ph: (505) 308-5226 |
| NPI Number | 1255896353 |
|---|---|
| Provider Enumeration Date | 02/04/2019 |
| Last Update Date | 10/05/2023 |
| Certification Date | 10/05/2023 |
| Medicare PECOS PAC ID | 4183060981 |
|---|---|
| Medicare Enrollment ID | O20240315000721 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255896353 | NPI | - | NPPES |
| 63238730 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jessica Rae Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245783760 PECOS PAC ID: 8628414422 Enrollment ID: I20240315001151 |
| Provider Name | Alyssa Kramer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255115143 PECOS PAC ID: 3173062080 Enrollment ID: I20240822004851 |
| Provider Name | Tara Mercedes Lobaina |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1669114427 PECOS PAC ID: 2769913581 Enrollment ID: I20241003004239 |
| Provider Name | Jens Brakenhoff |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508511700 PECOS PAC ID: 4587195292 Enrollment ID: I20241006000150 |
| Provider Name | Ryan Jerome Tingley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1790273027 PECOS PAC ID: 5496286106 Enrollment ID: I20241006000161 |
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