Provider Demographics
NPI:1043840028
Name:PACHECO, ELIZABETH (MC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 W AGUA FRIA FWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3946
Mailing Address - Country:US
Mailing Address - Phone:602-802-8386
Mailing Address - Fax:623-234-4774
Practice Address - Street 1:3050 W AGUA FRIA FWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3946
Practice Address - Country:US
Practice Address - Phone:602-802-8386
Practice Address - Fax:623-234-4774
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4902101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor