Healthcare Provider Details

I. General information

NPI: 1689185571
Provider Name (Legal Business Name): JULLLIENE REED-TSO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULLIENE (JAY) REED-TSO LCSW

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NEW SUNRISE RTC 20 MOCKINGBIRD DRIVE
SAN FIDEL NM
87049
US

IV. Provider business mailing address

PO BOX 219
SAN FIDEL NM
87049-0219
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-5500
  • Fax: 505-552-5530
Mailing address:
  • Phone: 505-552-5500
  • Fax: 505-552-5530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-0856
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: