Healthcare Provider Details

I. General information

NPI: 1154607810
Provider Name (Legal Business Name): BETH PIXLEY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 3RD ST NW
ALBUQUERQUE NM
87102-1401
US

IV. Provider business mailing address

PO BOX 66255
ALBUQUERQUE NM
87193-6255
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-8231
  • Fax:
Mailing address:
  • Phone: 505-459-0025
  • Fax: 505-899-8372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0116741
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: