Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003112665 |
---|---|
Provider Name | Tomasita Jasmine Smith |
First Address | Santa Fe, NM 87592-8220 |
Second Address | Las Vegas, NM 87701-4250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2011 |
Last Update Date | 31/01/2011 |