MEDICARE: SOMOS FAMILIA - FAMILY INST. INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	1041C0700X	Clinical Social Worker
5	106H00000X	Marriage & Family Therapist
6	104100000X	Social Worker

General Provider Information

NPI Number	:	1154483998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMOS FAMILIA - FAMILY INST. INC

Provider Business Mailing Address
First Line	:	312 BIBB INDUSTRIAL DRIVE
Second Line	:	PO BOX 638
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4055
Country	:	US
Telephone Number	:	505-425-8120
Fax Number	:	505-426-0190

Provider Business Practice Location Address
First Line	:	312 BIBB INDUSTRIAL DR
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-6287
Country	:	US
Telephone Number	:	505-425-8120
Fax Number	:	505-426-0190

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. TIM GALLEGOS
Credential	:
Telephone Number	:	505-425-8120

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/21/2022

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