Healthcare Provider Details

I. General information

NPI: 1487343968
Provider Name (Legal Business Name): ELIZABETH HAAGENSTAD PROFESSIONAL (LMHC)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SANDY WAY
SANTA FE NM
87506-7191
US

IV. Provider business mailing address

8500 MENAUL BLVD NE STE B460
ALBUQUERQUE NM
87112-2250
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-2921
  • Fax:
Mailing address:
  • Phone: 505-974-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCBT-2023-0515
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: