Provider Demographics
NPI:1306095989
Name:APODACA, ELIZABETH MARIE (MCFT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:APODACA
Suffix:
Gender:F
Credentials:MCFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10916 MAHLON AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4281
Mailing Address - Country:US
Mailing Address - Phone:505-410-6867
Mailing Address - Fax:
Practice Address - Street 1:2202 MENAUL BLVD NE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1726
Practice Address - Country:US
Practice Address - Phone:505-888-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT0116151101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health