Healthcare Provider Details

I. General information

NPI: 1457620817
Provider Name (Legal Business Name): MEREDITH BENTON ELEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PASEO DEL CANON W STE A
TAOS NM
87571-6943
US

IV. Provider business mailing address

PO BOX 1673
EL PRADO NM
87529-1673
US

V. Phone/Fax

Practice location:
  • Phone: 575-737-5533
  • Fax: 575-737-5534
Mailing address:
  • Phone: 510-980-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2023-0614
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164005585
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2024-1094
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: