MEDICARE: JAMIE SANDOVAL THERAPIES 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1780520189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMIE SANDOVAL THERAPIES LLC

Provider Business Mailing Address
First Line	:	718 CORONADO DR
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4906
Country	:	US
Telephone Number	:	505-617-1125
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 SOCORRO ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3353
Country	:	US
Telephone Number	:	505-617-1125
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MENTAL HEALTH COUNSELOR
Name	:	JAMIE SANDOVAL
Credential	:	LMHC
Telephone Number	:	505-617-1125

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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