Healthcare Provider Details

I. General information

NPI: 1831496769
Provider Name (Legal Business Name): BETH ELLEN HANCOCK MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11930 MENAUL BLVD NE STE 224A
ALBUQUERQUE NM
87112-2465
US

IV. Provider business mailing address

11930 MENAUL BLVD NE STE 224A
ALBUQUERQUE NM
87112-2465
US

V. Phone/Fax

Practice location:
  • Phone: 505-321-7831
  • Fax: 866-311-6623
Mailing address:
  • Phone: 505-321-7831
  • Fax: 866-311-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0137511
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: