Provider Demographics
NPI:1801073788
Name:CAIN, ELIZA (LMHC)
Entity type:Individual
Prefix:MS
First Name:ELIZA
Middle Name:
Last Name:CAIN
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:PO BOX 2916
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-2916
Mailing Address - Country:US
Mailing Address - Phone:505-660-2063
Mailing Address - Fax:
Practice Address - Street 1:413 SIPAPU ST # 6952
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6489
Practice Address - Country:US
Practice Address - Phone:575-758-5857
Practice Address - Fax:575-758-2832
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0112591101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health