Healthcare Provider Details

I. General information

NPI: 1215650486
Provider Name (Legal Business Name): TINA SANCHEZ PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 CHAMISA ST
SANTA FE NM
87505-3439
US

IV. Provider business mailing address

1909 CHAMISA ST
SANTA FE NM
87505-3439
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-4684
  • Fax:
Mailing address:
  • Phone: 505-750-4684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: TINA MARIE SANCHEZ
Title or Position: OWNER
Credential: LISW
Phone: 505-750-4684