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General NPI Number Information
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NPI Number | 1558018168
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Entity Type | Individual
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Provider Name | TARYN LEIGH CHURCH MA LMHC
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Gender | Female
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Dates
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Enumeration Date | 03/03/2022
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 475 E 20TH ST
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City | FARMINGTON
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State | NM
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Zip | 87401-2151
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Country | US
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Telephone | 505-327-0293
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Fax |
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Provider Business Mailing Address
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Address Line | 74 ROAD 3900
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City | FARMINGTON
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State | NM
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Zip | 87401-3203
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Country | US
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Telephone | 719-200-2905
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | T-CTL0222211
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License Number State | NM
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