Healthcare Provider Details

I. General information

NPI: 1043840028
Provider Name (Legal Business Name): ELIZABETH PACHECO MC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2020
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9935 S MIDLAND DR
APACHE JUNCTION AZ
85120-7157
US

IV. Provider business mailing address

3050 W AGUA FRIA FWY
PHOENIX AZ
85027-3946
US

V. Phone/Fax

Practice location:
  • Phone: 719-210-7162
  • Fax:
Mailing address:
  • Phone: 602-802-8386
  • Fax: 623-234-4774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19167
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4902
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: