Healthcare Provider Details

I. General information

NPI: 1740781947
Provider Name (Legal Business Name): ELIZA J COMBS LPCC, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZA J COMBS LPCC, ATR

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 ZAFARANO DR UNIT C
SANTA FE NM
87507-2669
US

IV. Provider business mailing address

1000 CORDOVA PLACE 395
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-216-6183
  • Fax:
Mailing address:
  • Phone: 505-216-6183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0187061
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: