Provider Demographics
NPI:1417583097
Name:SANTA MARIA, ELIZABETH (BHT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SANTA MARIA
Suffix:
Gender:F
Credentials:BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 W PRINCE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-3127
Mailing Address - Country:US
Mailing Address - Phone:520-887-2643
Mailing Address - Fax:
Practice Address - Street 1:1109 W PRINCE RD STE 111
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3127
Practice Address - Country:US
Practice Address - Phone:520-887-2643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor