Provider Demographics
NPI:1124680319
Name:XOCHIHUAN TRADITIONAL HEALING AND PSYCHOTHERAPHY, LLC
Entity type:Organization
Organization Name:XOCHIHUAN TRADITIONAL HEALING AND PSYCHOTHERAPHY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYSA
Authorized Official - Middle Name:P
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-450-6690
Mailing Address - Street 1:1006 JANE ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5612
Mailing Address - Country:US
Mailing Address - Phone:505-485-3060
Mailing Address - Fax:
Practice Address - Street 1:1006 JANE ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5612
Practice Address - Country:US
Practice Address - Phone:505-485-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27174751Medicaid