Healthcare Provider Details

I. General information

NPI: 1225450224
Provider Name (Legal Business Name): BENTLEY OLIVER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 HARPER DR NE SUITE 300
ALBUQUERQUE NM
87109-3573
US

IV. Provider business mailing address

138 DURHAM RD
ABBEVILLE SC
29620-5138
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-6609
  • Fax: 505-898-9372
Mailing address:
  • Phone: 505-385-5707
  • Fax: 505-898-9372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0181751
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: