Healthcare Provider Details

I. General information

NPI: 1578248753
Provider Name (Legal Business Name): HSP MARRIAGE FAMILY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 AUSTIN DR
LAS CRUCES NM
88001-5132
US

IV. Provider business mailing address

2075 AUSTIN DR
LAS CRUCES NM
88001-5132
US

V. Phone/Fax

Practice location:
  • Phone: 575-323-0604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: HOLLY PAZ
Title or Position: OWNER
Credential: LMFT
Phone: 575-323-0604