Provider Demographics
NPI:1578232773
Name:TWOFOOT, JAMIE (LMSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:TWOFOOT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W 19TH ST UNIT 9A
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-7351
Mailing Address - Country:US
Mailing Address - Phone:575-693-7555
Mailing Address - Fax:
Practice Address - Street 1:219 W 19TH ST UNIT 9A
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-7351
Practice Address - Country:US
Practice Address - Phone:575-693-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-10697104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker