Provider Demographics
NPI:1194029942
Name:SANCHEZ, JACQUELYN (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9583 HWY 337
Mailing Address - Street 2:
Mailing Address - City:ESTANCIA
Mailing Address - State:NM
Mailing Address - Zip Code:87016-9776
Mailing Address - Country:US
Mailing Address - Phone:575-571-1695
Mailing Address - Fax:
Practice Address - Street 1:9583 HWY 337
Practice Address - Street 2:
Practice Address - City:ESTANCIA
Practice Address - State:NM
Practice Address - Zip Code:87016-9776
Practice Address - Country:US
Practice Address - Phone:575-571-1695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NMCMF0183591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47043Medicaid