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General NPI Number Information
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NPI Number | 1578063863
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Entity Type | Organization
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Legal Business Name | RESILIENCE ZONE
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 02/14/2018
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Provider Practice Location Address
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Address Line | 4324 CORRALES RD STE 6
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City | CORRALES
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State | NM
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Zip | 87048-8607
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Country | US
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Telephone | 505-985-9833
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Fax |
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Provider Business Mailing Address
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Address Line | 1380 RIO RANCHO DR SE STE 153
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City | RIO RANCHO
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State | NM
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Zip | 87124-1006
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Country | US
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Telephone | 505-985-9833
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Fax |
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Authorized Official
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Title or Position | OWNER, PROVIDER
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Name | ELENA ABEYTA
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Credential | LMFT
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Telephone | 505-985-9833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0174031
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License Number State | NM
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