Healthcare Provider Details

I. General information

NPI: 1184501942
Provider Name (Legal Business Name): ELIAS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 CLEARWATER LOOP NE
RIO RANCHO NM
87144-5530
US

IV. Provider business mailing address

1865 CLEARWATER LOOP NE
RIO RANCHO NM
87144-5530
US

V. Phone/Fax

Practice location:
  • Phone: 505-451-4141
  • Fax:
Mailing address:
  • Phone: 505-451-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELIAS BURKE
Title or Position: OWNER
Credential:
Phone: 505-451-4141