Healthcare Provider Details

I. General information

NPI: 1073661336
Provider Name (Legal Business Name): HBJ THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 PUEBLO HAWIKUH
SANTA FE NM
87507-2514
US

IV. Provider business mailing address

3105 PUEBLO HAWIKUH
SANTA FE NM
87507-2514
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-7207
  • Fax:
Mailing address:
  • Phone: 505-690-7207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberT0074771
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0092121
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number631
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number443
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3262
License Number StateNM
# 6
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1721
License Number StateNM

VIII. Authorized Official

Name: SHANNON L. ENTERMAN
Title or Position: OWNER-BUSINESS MANAGER
Credential:
Phone: 505-690-7207