Healthcare Provider Details

I. General information

NPI: 1194736223
Provider Name (Legal Business Name): ELISE HENSLEY L.I.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

02 HORMIGA COURT
LOS LUNAS NM
87031-3319
US

IV. Provider business mailing address

P. O. BOX 3319
LOS LUNAS NM
87031-3319
US

V. Phone/Fax

Practice location:
  • Phone: 505-270-8778
  • Fax: 505-866-2282
Mailing address:
  • Phone: 505-270-8778
  • Fax: 505-866-2282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-04788
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: