Healthcare Provider Details

I. General information

NPI: 1144308685
Provider Name (Legal Business Name): NEIL KIM SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/13/2024
Certification Date: 01/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 N 5TH ST
GRAND JUNCTION CO
81501-7561
US

IV. Provider business mailing address

502 VISTA GRANDE DR
GRAND JUNCTION CO
81507-1436
US

V. Phone/Fax

Practice location:
  • Phone: 970-579-0003
  • Fax: 970-433-7671
Mailing address:
  • Phone: 970-236-8616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: