Provider Demographics
NPI:1750716502
Name:STERN, ELIZABETH WESTON (LMHC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:WESTON
Last Name:STERN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LARREA LANE
Mailing Address - Street 2:RANCHOS DE TAOS
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557
Mailing Address - Country:US
Mailing Address - Phone:575-758-3076
Mailing Address - Fax:
Practice Address - Street 1:1337 GUSDORF ROAD, SUITE E
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:575-758-4297
Practice Address - Fax:575-751-7237
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0158411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health