Healthcare Provider Details

I. General information

NPI: 1780520189
Provider Name (Legal Business Name): JAMIE SANDOVAL THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SOCORRO ST
LAS VEGAS NM
87701-3353
US

IV. Provider business mailing address

718 CORONADO DR
LAS VEGAS NM
87701-4906
US

V. Phone/Fax

Practice location:
  • Phone: 505-617-1125
  • Fax:
Mailing address:
  • Phone: 505-617-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JAMIE SANDOVAL
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 505-617-1125