Healthcare Provider Details

I. General information

NPI: 1790651230
Provider Name (Legal Business Name): ZEN HOUSE PSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N CAMPO ST
LAS CRUCES NM
88001-3433
US

IV. Provider business mailing address

330 N CAMPO ST
LAS CRUCES NM
88001-3433
US

V. Phone/Fax

Practice location:
  • Phone: 575-323-1662
  • Fax:
Mailing address:
  • Phone: 575-323-1662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ELYSA MICHELLE FRAGINALS
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 575-323-1662