Healthcare Provider Details

I. General information

NPI: 1578232773
Provider Name (Legal Business Name): JAMIE TWOFOOT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 W 2ND ST STE 1
PORTALES NM
88130-6614
US

IV. Provider business mailing address

219 W 19TH ST UNIT 9A
PORTALES NM
88130-7351
US

V. Phone/Fax

Practice location:
  • Phone: 575-693-7555
  • Fax:
Mailing address:
  • Phone: 575-693-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-0736
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: