Provider Demographics
NPI:1619348208
Name:XESUS THERAPY SERVICES
Entity Type:Organization
Organization Name:XESUS THERAPY SERVICES
Other - Org Name:XESUS HOUSE OF PRAYER, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO, BOARD DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERICA
Authorized Official - Middle Name:JALANE
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, RN
Authorized Official - Phone:585-343-1681
Mailing Address - Street 1:300 INTERNATIONAL DR
Mailing Address - Street 2:SUITE 117
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5781
Mailing Address - Country:US
Mailing Address - Phone:585-343-1681
Mailing Address - Fax:120-836-1866
Practice Address - Street 1:300 INTERNATIONAL DR
Practice Address - Street 2:SUITE 117
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5781
Practice Address - Country:US
Practice Address - Phone:585-343-1681
Practice Address - Fax:120-836-1866
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:XESUS HOUSE OF PRAYER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLMHC 006357;RN537485251S00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable