Provider Demographics
NPI:1740781947
Name:COMBS, ELIZA J (LPCC, ATR)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:J
Last Name:COMBS
Suffix:
Gender:F
Credentials:LPCC, ATR
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:J
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC, ATR
Mailing Address - Street 1:1000 CORDOVA PLACE
Mailing Address - Street 2:395
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-216-6183
Mailing Address - Fax:
Practice Address - Street 1:3450 ZAFARANO DR UNIT C
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2669
Practice Address - Country:US
Practice Address - Phone:505-216-6183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0187061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health