Healthcare Provider Details

I. General information

NPI: 1851875082
Provider Name (Legal Business Name): ELIJAH CHONG LPCC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 CERRILLOS RD
SANTA FE NM
87505-3373
US

IV. Provider business mailing address

405 SUNSET ST
SANTA FE NM
87501-1924
US

V. Phone/Fax

Practice location:
  • Phone: 979-492-0055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-CTL0198311
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10487
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0202161
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: