Healthcare Provider Details

I. General information

NPI: 1942339775
Provider Name (Legal Business Name): BEVERLY ANN BABIK LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TIERRA GRANDE
BELEN NM
87002-6465
US

IV. Provider business mailing address

30 TIERRA GRANDE
BELEN NM
87002-6465
US

V. Phone/Fax

Practice location:
  • Phone: 505-861-7235
  • Fax: 505-861-7235
Mailing address:
  • Phone: 505-861-7235
  • Fax: 505-861-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0820
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: