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General NPI Number Information
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NPI Number | 1417085796
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Entity Type | Individual
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Provider Name | LISA C MAVES M.A., LPC
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 110 SHEEP SPRINGS
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City | JEMEZ PUEBLO
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State | NM
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Zip | 87024
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Country | US
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Telephone | 505-834-3059
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Fax | 505-834-7093
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Provider Business Mailing Address
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Address Line | 5725 QUAY DR NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-5173
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Country | US
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Telephone | 505-771-9383
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Fax | 505-834-7903
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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 | 0070821
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License Number State | NM
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