Provider Demographics
NPI:1730445297
Name:HOZHO CENTER FOR PERSONAL ENHANCEMENT
Entity type:Organization
Organization Name:HOZHO CENTER FOR PERSONAL ENHANCEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAYT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CPSW
Authorized Official - Phone:505-870-1483
Mailing Address - Street 1:506 W HIGHWAY 66
Mailing Address - Street 2:#4
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-6468
Mailing Address - Country:US
Mailing Address - Phone:505-870-1483
Mailing Address - Fax:866-936-0697
Practice Address - Street 1:506 W HIGHWAY 66
Practice Address - Street 2:#4
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-6468
Practice Address - Country:US
Practice Address - Phone:505-870-1483
Practice Address - Fax:866-936-0697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4200184251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health