Healthcare Provider Details

I. General information

NPI: 1144012881
Provider Name (Legal Business Name): SACRED HEART INTEGRATIVE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5941 MILLER RD NE
RIO RANCHO NM
87144-7771
US

IV. Provider business mailing address

5941 MILLER RD NE
RIO RANCHO NM
87144-7771
US

V. Phone/Fax

Practice location:
  • Phone: 570-664-0441
  • Fax: 505-230-4851
Mailing address:
  • Phone: 570-350-8413
  • Fax: 505-230-4851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER J ALLEN
Title or Position: OWNER
Credential: LPC, LPCC
Phone: 570-664-0441