Healthcare Provider Details

I. General information

NPI: 1780740100
Provider Name (Legal Business Name): SHEENA BACHELOR-EVRIDGE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7027 MONTGOMERY BLVD NE STE F
ALBUQUERQUE NM
87109-1589
US

IV. Provider business mailing address

4100 BARBARA LOOP SE
RIO RANCHO NM
87124-1000
US

V. Phone/Fax

Practice location:
  • Phone: 505-880-0100
  • Fax: 505-880-0102
Mailing address:
  • Phone: 505-239-7128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: