Provider Demographics
NPI:1306682851
Name:SHEMOT PSYCHOSOCIAL INTERVENTIONS
Entity type:Organization
Organization Name:SHEMOT PSYCHOSOCIAL INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LA TONYA
Authorized Official - Middle Name:DELILAH
Authorized Official - Last Name:WESTRICK
Authorized Official - Suffix:
Authorized Official - Credentials:CPSW, CPS
Authorized Official - Phone:505-471-3000
Mailing Address - Street 1:1956 HOLLYHOCK CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2425
Mailing Address - Country:US
Mailing Address - Phone:505-471-3000
Mailing Address - Fax:
Practice Address - Street 1:1956 HOLLYHOCK CIR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2425
Practice Address - Country:US
Practice Address - Phone:505-471-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No282J00000XHospitalsReligious Nonmedical Health Care Institution