Individual
MS. ELOUISE BLACKGOAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COUNSELOR
Contact information
Practice address
300 W NIZHONI BLVD STE A, GALLUP, NM 87301
(505) 722-9470
(505) 722-9570
Mailing address
300 W NIZHONI BLVD STE A, GALLUP, NM 87301-5766
(505) 722-9470
(505) 722-9570
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0122361
NM
101YA0400X
Addiction (Substance Use Disorder) Counselor
0122361
NM
101YA0400X
Addiction (Substance Use Disorder) Counselor
11440
AZ
Other
Enumeration date
06/20/2007
Last updated
06/28/2018
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