Provider Demographics
NPI:1588912901
Name:ALBAN, ELENA MORTEL
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:MORTEL
Last Name:ALBAN
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 1:2106 ROUNDHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4217
Mailing Address - Country:US
Mailing Address - Phone:805-712-4557
Mailing Address - Fax:
Practice Address - Street 1:2106 ROUNDHOUSE RD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-4217
Practice Address - Country:US
Practice Address - Phone:805-712-4557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health