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270 Michael Ave Sw Los Lunas NM 87031-7388 | |
| (270) 535-6764 | |
| (505) 657-5666 |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 270 Michael Ave Sw, Los Lunas, New Mexico |
| Authorized Official Name and Position | Jacob Hamlin (OFFICER) |
| Authorized Official Contact | 2705356764 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
270 Michael Ave Sw Los Lunas NM 87031-7388 Ph: (270) 535-6764 | 270 Michael Ave Sw Los Lunas NM 87031-7388 Ph: (270) 535-6764 |
| NPI Number | 1790446441 |
|---|---|
| Provider Enumeration Date | 01/05/2022 |
| Last Update Date | 11/10/2023 |
| Certification Date | 11/10/2023 |
| Medicare PECOS PAC ID | 9032653001 |
|---|---|
| Medicare Enrollment ID | O20240701003595 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790446441 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Jacob M Hamlin |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1578973384 PECOS PAC ID: 0941744916 Enrollment ID: I20240701003693 |
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