Healthcare Provider Details

I. General information

NPI: 1750563235
Provider Name (Legal Business Name): ALLISON CHRISTINE ELSE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 TEXAS STREET SE
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

12441 PROSPECT AVE NE
ALBUQUERQUE NM
87112-3648
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5885
  • Fax:
Mailing address:
  • Phone: 608-343-2477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2022-0695
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: