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NPI Code Detail

MEDICARE: MS. TINA LORRAINE BEZONA LPC

MEDICARE: MS. TINA LORRAINE BEZONA LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor4266CO

General Provider Information

NPI Number : 1003031287
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TINA LORRAINE BEZONA LPC
Provider Business Mailing Address
First Line : 1183 S CAMINO SANTIAGO DR
Second Line :
City : PUEBLO WEST
State : CO
Zip : 81007-1904
Country : US
Telephone Number : 719-651-9301
Fax Number : 719-547-8171
Provider Business Practice Location Address
First Line : 107 S 9TH ST
Second Line :
City : CANON CITY
State : CO
Zip : 81212-3800
Country : US
Telephone Number : 719-430-5929
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2007
Last Update Date : 01/19/2024

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