Provider Demographics
NPI:1114033602
Name:THRIFT, ELSIE KATHERINE (LPCC)
Entity Type:Individual
Prefix:MS
First Name:ELSIE
Middle Name:KATHERINE
Last Name:THRIFT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6537
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-6537
Mailing Address - Country:US
Mailing Address - Phone:505-471-2533
Mailing Address - Fax:505-474-8198
Practice Address - Street 1:1533 S SAINT FRANCIS DR
Practice Address - Street 2:STE. E
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4032
Practice Address - Country:US
Practice Address - Phone:505-988-4131
Practice Address - Fax:505-992-6145
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0068962101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA 1096Medicaid