Provider Demographics
NPI:1255699393
Name:TAOS FAMILY AND COUPLES INSTITUTE
Entity type:Organization
Organization Name:TAOS FAMILY AND COUPLES INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHUA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:224-628-6373
Mailing Address - Street 1:65 LAS TUSAS RD
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-8849
Mailing Address - Country:US
Mailing Address - Phone:224-628-6373
Mailing Address - Fax:
Practice Address - Street 1:827 PASEO DEL PUEBLO NORTE
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6887
Practice Address - Country:US
Practice Address - Phone:224-628-6373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0146101251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00159549Medicaid