Healthcare Provider Details

I. General information

NPI: 1326110453
Provider Name (Legal Business Name): ELBA VELEZ TRUE LPCC LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SHEEP SPRINGS WAY
JEMEZ PUEBLO NM
87024
US

IV. Provider business mailing address

91A OJO RD
JEMEZ PUEBLO NM
87024-9606
US

V. Phone/Fax

Practice location:
  • Phone: 505-834-7258
  • Fax: 505-834-9507
Mailing address:
  • Phone: 505-429-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0069442
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0071701
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: