| Doctor Name: | ELOIS M MCKINZIE |
| NPI Number: | 1013088624 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA MSW LISW |
| License Number: | I-04892 |
| Business Practice Address: | 1390 E 20th St Farmington, NM - 874019037 |
| Business Phone Number: | 5055998535 |
| Business Fax Number: | 5055998536 |
| Mailing Address: | 1390 E 20th St, FARMINGTON |
| State: | NM |
| Postal Code: | 874019037 |
| Phone Number: | 5055998535 |
| Fax Number: | 5055998536 |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | I-04892 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |