Provider Demographics
NPI:1578755765
Name:FLORES-MADRID, EILEEN (MS LMHC)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:FLORES-MADRID
Suffix:
Gender:F
Credentials:MS LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S DON ROSER DR
Mailing Address - Street 2:F-1
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4567
Mailing Address - Country:US
Mailing Address - Phone:505-521-4848
Mailing Address - Fax:505-522-1798
Practice Address - Street 1:1401 S DON ROSER DR
Practice Address - Street 2:F-1
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4567
Practice Address - Country:US
Practice Address - Phone:505-521-4848
Practice Address - Fax:505-522-1798
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0103771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health