Provider Demographics
NPI:1730701970
Name:PRESLAR, JENNIFER (MS, LCGC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PRESLAR
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WILLOW BACK RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-1484
Mailing Address - Country:US
Mailing Address - Phone:843-655-4701
Mailing Address - Fax:
Practice Address - Street 1:4801 BECKNER RD STE 2750
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3641
Practice Address - Country:US
Practice Address - Phone:505-984-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0139000050170300000X
NMGC2020-005101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No170300000XOther Service ProvidersGenetic Counselor, MS