Healthcare Provider Details

I. General information

NPI: 1831349166
Provider Name (Legal Business Name): ELIZABETH KESSLER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 DON PASQUAL RD NW
LOS LUNAS NM
87031-8493
US

IV. Provider business mailing address

PO BOX 518
LOS LUNAS NM
87031-0518
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-3350
  • Fax:
Mailing address:
  • Phone: 505-865-1408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0116571
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: