Provider Demographics
NPI:1487343968
Name:HAAGENSTAD, ELIZABETH (INTERN MENTAL HEALTH)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HAAGENSTAD
Suffix:
Gender:F
Credentials:INTERN MENTAL HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 PORVENIR LN UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1144
Mailing Address - Country:US
Mailing Address - Phone:505-699-2921
Mailing Address - Fax:
Practice Address - Street 1:746 PORVENIR LN UNIT 2
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1144
Practice Address - Country:US
Practice Address - Phone:505-699-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health