Provider Demographics
NPI:1811396823
Name:YERENDE, EFSTATHIA
Entity Type:Individual
Prefix:
First Name:EFSTATHIA
Middle Name:
Last Name:YERENDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2353
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-2353
Mailing Address - Country:US
Mailing Address - Phone:505-795-3822
Mailing Address - Fax:
Practice Address - Street 1:530 DE MOSS ST
Practice Address - Street 2:
Practice Address - City:LORDSBURG
Practice Address - State:NM
Practice Address - Zip Code:88045
Practice Address - Country:US
Practice Address - Phone:575-542-8384
Practice Address - Fax:575-313-8236
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0191301101YM0800X
TX83439101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health