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General NPI Number Information
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NPI Number | 1457620817
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Entity Type | Individual
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Provider Name | MEREDITH BENTON ELEY
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Gender | Female
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 105 PASEO DEL CANON W STE A
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City | TAOS
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State | NM
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Zip | 87571-6943
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Country | US
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Telephone | 575-737-5533
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Fax | 575-737-5534
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Provider Business Mailing Address
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Address Line | PO BOX 1673
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City | EL PRADO
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State | NM
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Zip | 87529-1673
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Country | US
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Telephone | 510-980-1398
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CTB-2023-0614
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 164005585
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SWB-2024-1094
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License Number State | NM
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