Healthcare Provider Details

I. General information

NPI: 1619470671
Provider Name (Legal Business Name): ELIZABETH ALLEN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH TRAWICK LMHC

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10555 MONTGOMERY BLVD NE BLDG 2
ALBUQUERQUE NM
87111-3857
US

IV. Provider business mailing address

10555 MONTGOMERY BLVD NE BLDG 2
ALBUQUERQUE NM
87111-3857
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-7946
  • Fax: 505-503-7947
Mailing address:
  • Phone: 505-503-7946
  • Fax: 505-503-7947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0180611
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: