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General NPI Number Information
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NPI Number | 1790651230
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Entity Type | Organization
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Legal Business Name | ZEN HOUSE PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 330 N CAMPO ST
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City | LAS CRUCES
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State | NM
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Zip | 88001-3433
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Country | US
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Telephone | 575-323-1662
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Fax |
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Provider Business Mailing Address
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Address Line | 330 N CAMPO ST
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City | LAS CRUCES
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State | NM
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Zip | 88001-3433
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Country | US
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Telephone | 575-323-1662
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | ELYSA MICHELLE FRAGINALS
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Credential | PSY.D.
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Telephone | 575-323-1662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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