Provider Demographics
NPI:1104669993
Name:XESUS HOUSE OF PRAYER, INC.
Entity type:Organization
Organization Name:XESUS HOUSE OF PRAYER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, PRESIDENT, CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JERICA
Authorized Official - Middle Name:JALANE
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ, LMHC, RN
Authorized Official - Phone:716-406-4246
Mailing Address - Street 1:135 LYNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-3023
Mailing Address - Country:US
Mailing Address - Phone:716-463-1698
Mailing Address - Fax:
Practice Address - Street 1:300 INTERNATIONAL DR STE 100
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5783
Practice Address - Country:US
Practice Address - Phone:716-406-4246
Practice Address - Fax:716-463-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No102X00000XBehavioral Health & Social Service ProvidersPoetry TherapistGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC1400XNursing Service ProvidersRegistered NurseCollege HealthGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty