Healthcare Provider Details

I. General information

NPI: 1568188647
Provider Name (Legal Business Name): ELENA GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 GOLF COURSE RD SE STE D
RIO RANCHO NM
87124-1760
US

IV. Provider business mailing address

2101 GOLF COURSE RD SE STE D
RIO RANCHO NM
87124-1760
US

V. Phone/Fax

Practice location:
  • Phone: 505-419-8885
  • Fax: 505-419-8885
Mailing address:
  • Phone: 505-419-8885
  • Fax: 505-212-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2023-0669
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: