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General NPI Number Information
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NPI Number | 1134934490
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Entity Type | Individual
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Provider Name | ELENA MARQUEZ LSW
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Gender | Female
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 4776 EAGLERIDGE CIR
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City | PUEBLO
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State | CO
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Zip | 81008-2120
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Country | US
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Telephone | 719-553-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 519 COMANCHE VILLAGE DR
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City | FOUNTAIN
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State | CO
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Zip | 80817-1668
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Country | US
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Telephone | 719-406-8326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0009925982
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 0009925982
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License Number State | CO
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