Basic Information
| Provider Information | |||||||||
| NPI: | 1104179027 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEYFFERT | ||||||||
| FirstName: | JAIME | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1219 BARRANCA DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799354601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157795600 | ||||||||
| FaxNumber: | 9157795605 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 MCCOMBS RD | ||||||||
| Address2: | SPC C | ||||||||
| City: | CHAPARRAL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880817937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5758245340 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2012 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0153451 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.