Provider Demographics
NPI:1295308195
Name:GALANIS, ELISABETH LEILANI (PROVISIONAL LMHC)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:LEILANI
Last Name:GALANIS
Suffix:
Gender:F
Credentials:PROVISIONAL LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 MONTGOMERY BLVD NE STE 5
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2468
Mailing Address - Country:US
Mailing Address - Phone:505-203-5094
Mailing Address - Fax:
Practice Address - Street 1:9201 MONTGOMERY BLVD NE STE 5
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2468
Practice Address - Country:US
Practice Address - Phone:505-203-5094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NMCTB-2024-0438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator