Provider Demographics
NPI:1043393184
Name:MAINES, ELIZABETH BELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BELLE
Last Name:MAINES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-5823
Mailing Address - Country:US
Mailing Address - Phone:505-973-2022
Mailing Address - Fax:
Practice Address - Street 1:1096 MECHEM DR STE 205
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7068
Practice Address - Country:US
Practice Address - Phone:505-973-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18791103TC0700X
NM0985103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL187910Medicare ID - Type Unspecified