Provider Demographics
NPI:1457543753
Name:PARDUE, ELISE (LPCC)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:PARDUE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:BARKSDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:TESUQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87574
Mailing Address - Country:US
Mailing Address - Phone:505-699-5533
Mailing Address - Fax:
Practice Address - Street 1:2960 RODEO PARK DR W
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6351
Practice Address - Country:US
Practice Address - Phone:505-986-9633
Practice Address - Fax:505-474-4663
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0112961101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional