Provider Demographics
NPI:1689125908
Name:DANIEL, ELBA (LPCC)
Entity Type:Individual
Prefix:
First Name:ELBA
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:ELBA
Other - Middle Name:
Other - Last Name:NIETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:304 W GRIGGS AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2603
Mailing Address - Country:US
Mailing Address - Phone:915-238-6926
Mailing Address - Fax:
Practice Address - Street 1:304 W GRIGGS AVE STE 20
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2603
Practice Address - Country:US
Practice Address - Phone:915-238-6926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0209311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM64153274Medicaid