Healthcare Provider Details

I. General information

NPI: 1437041332
Provider Name (Legal Business Name): KINSHIP EQUINE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 SANGRE DE CRISTO HWY
LAS VEGAS NM
87701-7444
US

IV. Provider business mailing address

PO BOX 428
LAS VEGAS NM
87701-0428
US

V. Phone/Fax

Practice location:
  • Phone: 505-617-0202
  • Fax:
Mailing address:
  • Phone: 505-617-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: VANESSA D LUCERO
Title or Position: PRESIDENT
Credential: LCSW
Phone: 505-617-0202