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General NPI Number Information
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NPI Number | 1104669993
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Entity Type | Organization
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Legal Business Name | XESUS HOUSE OF PRAYER, INC.
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Dates
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Enumeration Date | 06/18/2024
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 300 INTERNATIONAL DR STE 100
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5783
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Country | US
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Telephone | 716-406-4246
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Fax | 716-463-1698
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Provider Business Mailing Address
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Address Line | 135 LYNDALE AVE
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City | BUFFALO
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State | NY
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Zip | 14223-3023
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Country | US
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Telephone | 716-463-1698
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Fax |
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Authorized Official
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Title or Position | FOUNDER, PRESIDENT, CEO
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Name | MS. JERICA JALANE BARBER
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Credential | ESQ., LMHC, RN
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Telephone | 716-406-4246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 102X00000X
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Taxonomy Name | Poetry Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 163WC1400X
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Taxonomy Name | College Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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