Provider Demographics
NPI:1164146981
Name:PINA, ELISA M (LMHC)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:M
Last Name:PINA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 MOSSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8271
Mailing Address - Country:US
Mailing Address - Phone:575-551-4061
Mailing Address - Fax:
Practice Address - Street 1:2360 INDIAN WELLS RD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4609
Practice Address - Country:US
Practice Address - Phone:575-437-7404
Practice Address - Fax:575-439-2860
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2002-0054101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health