| Doctor Name: | MS. ELOUISE BLACKGOAT |
| NPI Number: | 1043415854 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | COUNSELOR |
| License Number: | 11440 |
| Business Practice Address: | 196 E Highway 66 Gallup, NM - 873016232 |
| Business Phone Number: | 5057229470 |
| Business Fax Number: | 5057229570 |
| Mailing Address: | Po Box 452, GALLUP |
| State: | NM |
| Postal Code: | 873050452 |
| Phone Number: | 5057229472 |
| Fax Number: | 5057229570 |
| NPI Enumeration Date: | 06/20/2007 |
| NPI Last Update Date: | 08/31/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 11440 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |