Healthcare Provider Details

I. General information

NPI: 1972778066
Provider Name (Legal Business Name): CRISTIN ELIZABETH PONDER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 MENAUL BLVD NE SUITE B C D
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

PO BOX 92002 FORENSIC BEHAVIORAL HEALTH
ALBUQUERQUE NM
87199
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-5499
  • Fax: 505-888-5498
Mailing address:
  • Phone: 505-888-5499
  • Fax: 505-888-5498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0098191
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: