Provider Demographics
NPI:1063817898
Name:SANCHEZ, THERESA GRACE
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:GRACE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-4917
Mailing Address - Country:US
Mailing Address - Phone:915-497-2335
Mailing Address - Fax:
Practice Address - Street 1:1207 8TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5834
Practice Address - Country:US
Practice Address - Phone:575-437-9340
Practice Address - Fax:575-434-6629
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-08682104100000X
TX624031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX62403OtherLCSW