Provider Demographics
NPI:1841460664
Name:EPALOOSE, FAE M (LPCC)
Entity type:Individual
Prefix:
First Name:FAE
Middle Name:M
Last Name:EPALOOSE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 E AZTEC AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4803
Mailing Address - Country:US
Mailing Address - Phone:058-633-8285
Mailing Address - Fax:505-443-4345
Practice Address - Street 1:2025 E AZTEC AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4803
Practice Address - Country:US
Practice Address - Phone:505-633-8288
Practice Address - Fax:505-443-4345
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0135721101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional