MEDICARE: ELIAS THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1184501942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIAS THERAPY LLC

Provider Business Mailing Address
First Line	:	1865 CLEARWATER LOOP NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-5530
Country	:	US
Telephone Number	:	505-451-4141
Fax Number	:

Provider Business Practice Location Address
First Line	:	1865 CLEARWATER LOOP NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-5530
Country	:	US
Telephone Number	:	505-451-4141
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELIAS BURKE
Credential	:
Telephone Number	:	505-451-4141

Provider Enumeration Date	:	08/21/2025
Last Update Date	:	04/10/2026

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Directions to “ELIAS THERAPY LLC ” Practice Location

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