MEDICARE: TINA SANCHEZ PSYCHOTHERAPY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1215650486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TINA SANCHEZ PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	1909 CHAMISA ST
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-3439
Country	:	US
Telephone Number	:	505-750-4684
Fax Number	:

Provider Business Practice Location Address
First Line	:	1909 CHAMISA ST
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-3439
Country	:	US
Telephone Number	:	505-750-4684
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TINA MARIE SANCHEZ
Credential	:	LISW
Telephone Number	:	505-750-4684

Provider Enumeration Date	:	09/22/2022
Last Update Date	:	09/22/2022

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