Healthcare Provider Details

I. General information

NPI: 1457598666
Provider Name (Legal Business Name): RICHARD SCOTT BEAN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6312 MONTANO RD NW STE A
ALBUQUERQUE NM
87120-2170
US

IV. Provider business mailing address

6312 MONTANO RD NW STE A
ALBUQUERQUE NM
87120-2170
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-1155
  • Fax: 505-717-1155
Mailing address:
  • Phone: 505-717-1155
  • Fax: 505-717-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number111401
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: