Provider Demographics
NPI:1326920398
Name:KINSHIP THERAPY LLC
Entity type:Organization
Organization Name:KINSHIP THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LUCERO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-617-0202
Mailing Address - Street 1:741 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4918
Mailing Address - Country:US
Mailing Address - Phone:505-617-0202
Mailing Address - Fax:
Practice Address - Street 1:741 TERRACE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4918
Practice Address - Country:US
Practice Address - Phone:505-617-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1437041332Medicaid