Healthcare Provider Details

I. General information

NPI: 1689663536
Provider Name (Legal Business Name): ELISABETH C HOLLAND LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 ALTO ST
SANTA FE NM
87501-2406
US

IV. Provider business mailing address

1035 ALTO ST
SANTA FE NM
87501-2406
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-6241
  • Fax: 505-982-6280
Mailing address:
  • Phone: 505-982-6241
  • Fax: 505-982-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1955
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: