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General NPI Number Information
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NPI Number | 1255699393
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Entity Type | Organization
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Legal Business Name | TAOS FAMILY AND COUPLES INSTITUTE
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 827 PASEO DEL PUEBLO NORTE
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City | TAOS
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State | NM
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Zip | 87571-6887
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Country | US
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Telephone | 224-628-6373
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Fax |
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Provider Business Mailing Address
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Address Line | 65 LAS TUSAS RD
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City | RANCHOS DE TAOS
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State | NM
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Zip | 87557-8849
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Country | US
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Telephone | 224-628-6373
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JANICE L CHUA
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Credential | LMFT
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Telephone | 224-628-6373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0146101
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License Number State | NM
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