Healthcare Provider Details

I. General information

NPI: 1306095989
Provider Name (Legal Business Name): ELIZABETH MARIE APODACA MCFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 MENAUL BLVD NE SUITE C
ALBUQUERQUE NM
87107-1726
US

IV. Provider business mailing address

10916 MAHLON AVE NE
ALBUQUERQUE NM
87112-4281
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-5499
  • Fax:
Mailing address:
  • Phone: 505-410-6867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT0116151
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: