Provider Demographics
NPI:1407694425
Name:APODACA, KRISTA MAYAH
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MAYAH
Last Name:APODACA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 ABERDEEN CT
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-8101
Mailing Address - Country:US
Mailing Address - Phone:915-996-6813
Mailing Address - Fax:
Practice Address - Street 1:5802 ABERDEEN CT
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-8101
Practice Address - Country:US
Practice Address - Phone:915-996-6813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health