Provider Demographics
NPI:1194736223
Name:HENSLEY, ELISE (LISW)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 3319
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-3319
Mailing Address - Country:US
Mailing Address - Phone:505-270-8778
Mailing Address - Fax:505-866-2282
Practice Address - Street 1:02 HORMIGA COURT
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-3319
Practice Address - Country:US
Practice Address - Phone:505-270-8778
Practice Address - Fax:505-866-2282
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-047881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM81202229Medicaid