Provider Demographics
NPI:1144212168
Name:MADRID, NANCY ELIZABETH (LPCC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ELIZABETH
Last Name:MADRID
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 1:10701 PROSPECT AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3261
Mailing Address - Country:US
Mailing Address - Phone:505-323-1284
Mailing Address - Fax:505-323-1284
Practice Address - Street 1:10701 PROSPECT AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3261
Practice Address - Country:US
Practice Address - Phone:505-323-1284
Practice Address - Fax:505-323-1284
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3057101YM0800X
NMD069022101YP2500X
TX11411101YP2500X
NM282432101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM10071OtherVALUE OPTIONS
NM541470OtherVALUE OPTIONS
NM42179351Medicaid
NM89998OtherPRESBYTERIAN