Healthcare Provider Details

I. General information

NPI: 1629166301
Provider Name (Legal Business Name): BEVERLY JEANNE BENTZEN DAVIES LPCC LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BEVERLY DAVIES LPCC LMFT

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 ACADEMY RD NE
ALBUQUERQUE NM
87111-1107
US

IV. Provider business mailing address

8600 ACADEMY RD NE
ALBUQUERQUE NM
87111-1107
US

V. Phone/Fax

Practice location:
  • Phone: 505-821-3628
  • Fax: 508-856-7103
Mailing address:
  • Phone: 505-821-3628
  • Fax: 505-856-7103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCMF2814
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0868
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: