Individual
ELIZABETH ANN PENLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4005 HIGH RESORT BLVD SE, PMG RIO RANCHO HIGH RESORT 4005, RIO RANCHO, NM 87124-5906
(505) 291-2402
(505) 291-2490
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
0797
NM
103TA0700X
Adult Development & Aging Psychologist
Primary
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0200X
Forensic Psychologist
—
—
Other
Enumeration date
11/21/2006
Last updated
09/05/2014
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