Healthcare Provider Details

I. General information

NPI: 1013316728
Provider Name (Legal Business Name): RENEE BRITTANY BENAVIDEZ LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 SAN PEDRO DR NE STE 100
ALBUQUERQUE NM
87110-4133
US

IV. Provider business mailing address

4800 SAN MATEO LN NE APT 202
ALBUQUERQUE NM
87109-2401
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-1811
  • Fax: 505-639-4309
Mailing address:
  • Phone: 505-506-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0208211
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: