Basic Information
| Provider Information | |||||||||
| NPI: | 1326449158 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEVARGAS | ||||||||
| FirstName: | ELISA | ||||||||
| MiddleName: | CATALINA | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 UNIVERSITY OF NEW MEXICO | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8200 CENTRAL AVE SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871082408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052725885 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2014 | ||||||||
| LastUpdateDate: | 08/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 390200000X | NM | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103T00000X | PSY1558 | NM | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.