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General NPI Number Information
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NPI Number | 1689060493
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Entity Type | Organization
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Legal Business Name | ELIZABETH PENLAND PHD
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Dates
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Enumeration Date | 04/08/2015
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 4011 BARBARA LOOP SE STE 207
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City | RIO RANCHO
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State | NM
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Zip | 87124-1039
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Country | US
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Telephone | 505-896-3444
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Fax | 505-994-9194
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Provider Business Mailing Address
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Address Line | 4011 BARBARA LOOP SE STE 207
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City | RIO RANCHO
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State | NM
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Zip | 87124-1039
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Country | US
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Telephone | 505-896-3444
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Fax | 505-994-9194
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. ELIZABETH A PENLAND
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Credential | PH.D.
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Telephone | 505-896-3444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0709
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License Number State | NM
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